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Garcia TB, Kliemt R, Claus F, Neumann A, Soltmann B, Baum F, Schwarz J, Swart E, Schmitt J, Pfennig A, Häckl D, Weinhold I. Agreement between self-reports and statutory health insurance claims data on healthcare utilization in patients with mental disorders. BMC Health Serv Res 2023; 23:1243. [PMID: 37951906 PMCID: PMC10640759 DOI: 10.1186/s12913-023-10175-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Data on resource use are frequently required for healthcare assessments. Studies on healthcare utilization (HCU) in individuals with mental disorders have analyzed both self-reports and administrative data. Source of data may affect the quality of analysis and compromise the accuracy of results. We sought to ascertain the degree of agreement between self-reports and statutory health insurance (SHI) fund claims data from patients with mental disorders. METHODS Claims data from six German SHI and self-reports were obtained along with a cost-effectiveness analysis performed as a part of a controlled prospective multicenter cohort study conducted in 18 psychiatric hospitals in Germany (PsychCare), including patients with pre-defined psychiatric disorders. Self-reports were collected using the German adaption of the Client Sociodemographic and Service Receipt Inventory (CSSRI) questionnaire with a 6-month recall period. Data linkage was performed using a unique pseudonymized identifier. Missing responses were coded as non-use for all analyses. HCU was calculated for inpatient and outpatient care, day-care services, home treatment, and pharmaceuticals. Concordance was measured using Cohen's Kappa (κ) and intraclass correlation coefficient (ICC). Regression approaches were used to investigate the effect of independent variables on the agreements. RESULTS In total 274 participants (mean age 47.8 [SD = 14.2] years; 47.08% women) were included in the analysis. No significant differences were observed between the linked and unlinked patients in terms of baseline characteristics. Total agreements values were 63.9% (κ = 0.03; PABAK = 0.28) for outpatient contacts, 69.3% (κ = 0.25; PABAK = 0.39) for medication use, 81.0% (κ = 0.56; PABAK = 0.62) for inpatient days and 86.1% (κ = 0.67; PABAK = 0.72) for day-care services. There was varied quantitative agreement between data sources, with the poorest agreement for outpatient care (ICC [95% CI] = 0.22 [0.10-0.33]) and the best for psychiatric day-care services (ICC [95% CI] = 0.72 [0.66-0.78]). Marital status and time since first treatment positively affected the chance of agreement on utilization of outpatient services. CONCLUSIONS Although there were high levels of absolute agreement, the measures of concordance between administrative records and self-reports were generally minimal to moderate. Healthcare investigations should consider using linked or at least different data sources to estimate HCU for specific utilization areas, where unbiased information can be expected. TRIAL REGISTRATION This study was part of the multi-center controlled PsychCare trial (German Clinical Trials Register No. DRKS00022535; Date of registration: 2020-10-02).
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Affiliation(s)
- Tarcyane Barata Garcia
- WIG2 Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany.
| | - Roman Kliemt
- WIG2 Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany
| | - Franziska Claus
- WIG2 Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany
| | - Anne Neumann
- Center of Evidence-Based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Bettina Soltmann
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Fabian Baum
- Center of Evidence-Based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Julian Schwarz
- Brandenburg Medical School, University Clinic for Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Enno Swart
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-Von-Guericke- University Magdeburg, Magdeburg, Germany
| | - Jochen Schmitt
- Center of Evidence-Based Health Care, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andrea Pfennig
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Dennis Häckl
- WIG2 Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany
- Institute of Public Finance and Public Management, Faculty of Economics and Management Science, Leipzig University, Leipzig, Germany
| | - Ines Weinhold
- WIG2 Institute for Health Economics and Health System Research, Markt 8, 04109, Leipzig, Germany
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Savelli E, Murmura F. The intention to consume healthy food among older Gen-Z: Examining antecedents and mediators. Food Qual Prefer 2023. [DOI: 10.1016/j.foodqual.2022.104788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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García-Velázquez R, Kieseppä V, Lilja E, Koponen P, Skogberg N, Kuusio H. A multisource approach to health care use: concordance between register and self-reported physician visits in the foreign-born population in Finland. BMC Med Res Methodol 2022; 22:309. [PMID: 36460964 PMCID: PMC9717412 DOI: 10.1186/s12874-022-01780-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/31/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Reliable information on the use of health services is important for health care planning, monitoring and policy. It is critical to assess the validity of the sources used for this purpose, including register and survey-based data. Studies on foreign-born populations' health care use have usually implemented either survey or register data. The concordance of such data among groups of different cultural background remains largely unknown. In this study, we presented an approach to examine routinely how survey and register-related characteristics may explain disagreement found between the two information sources. METHODS We linked register- and survey-based data pertaining to the Finnish Register of Primary Health Care general physician visits and the Survey on Well-Being among Foreign Born Population (FinMonik, 2018-2019), a nationally representative survey. The sample comprised n = 5,800 informants for whom registered general physician visits were tracked in the 12-month period preceding their participation in the survey. Cohen's kappa was used as measure of multisource concordance, hierarchical loglinear models for the association between single predictors and multisource discrepancy, and a logistic regression model for examining source-related predictors of source discrepancy. Survey weights were used in all sample analyses. RESULTS Source concordance was poor. When dichotomizing general physician visits (zero vs one or more), 35% of informants had reported one or more visits while none were found from register. Both register- and informant-related predictors were associated to this discrepancy (i.e. catchment area, private health care use, inability to work, region of origin and reason for migration). CONCLUSIONS We found high discrepancy between the reported and the registered physician visits among the foreign-born population in Finland, with a particularly high number of reported physician visits when none were found in the register. There was a strong association between the specific catchment area and mismatch, indicating that both register under-coverage and survey over-report are plausible and may coexist behind the discrepancy. However, associations of informant's characteristics and mismatch were less pronounced. Implications on the validity of medical information sources are discussed.
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Affiliation(s)
- Regina García-Velázquez
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Valentina Kieseppä
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Eero Lilja
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Päivikki Koponen
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Natalia Skogberg
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
| | - Hannamaria Kuusio
- grid.14758.3f0000 0001 1013 0499Finnish Institute for Health and Welfare, Mannerheimintie 166, PL/PB/P.O. Box 30, FI-00271 Helsinki, Finland
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Relationship between Vitamin C Deficiency and Cognitive Impairment in Older Hospitalised Patients: A Cross-Sectional Study. Antioxidants (Basel) 2022; 11:antiox11030463. [PMID: 35326113 PMCID: PMC8944675 DOI: 10.3390/antiox11030463] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 02/07/2023] Open
Abstract
Vitamin C is a powerful antioxidant and facilitates neurotransmission. This study explored association between vitamin C deficiency and cognitive impairment in older hospitalised patients. This prospective study recruited 160 patients ≥ 75 years admitted under a Geriatric Unit in Australia. Cognitive assessment was performed by use of the Mini-Mental-State-Examination (MMSE) and patients with MMSE scores <24 were classified as cognitively-impaired. Fasting plasma vitamin C levels were determined using high-performance-liquid-chromatography. Patients were classified as vitamin C deficient if their levels were below 11 micromol/L. Logistic regression analysis was used to determine whether vitamin C deficiency was associated with cognitive impairment after adjustment for various covariates. The mean (SD) age was 84.4 (6.4) years and 60% were females. A total of 91 (56.9%) were found to have cognitive impairment, while 42 (26.3%) were found to be vitamin C deficient. The mean (SD) MMSE scores were significantly lower among patients who were vitamin C deficient (24.9 (3.3) vs. 23.6 (3.4), p-value = 0.03). Logistic regression analysis suggested that vitamin C deficiency was 2.9-fold more likely to be associated with cognitive impairment after adjustment for covariates (aOR 2.93, 95% CI 1.05−8.19, p-value = 0.031). Vitamin C deficiency is common and is associated with cognitive impairment in older hospitalised patients.
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Corchuelo-Ojeda J, González Pérez GJ, Casas-Arcila A. Factors Associated With Self-Perception in Oral Health of Pregnant Women. HEALTH EDUCATION & BEHAVIOR 2021; 49:516-524. [PMID: 34955047 PMCID: PMC9149525 DOI: 10.1177/10901981211038903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Health perception is a subjective predictor of long-term morbidity and
mortality. Few studies address the perception that pregnant women have of
their oral health. Objective The objective of this study was to explore the relationship between
socioeconomic factors and self-assessment of oral health in pregnant women
from Cali, Colombia. Method A cross-sectional study was carried out with a sample of 998 pregnant women,
calculated using the formula to estimate a proportion in finite populations,
with a confidence level of 95%. A questionnaire was applied for
sociodemographic characterization, as well as to enquire about oral health
perception, knowledge, and practices of oral health. Results The mean age of the surveyed mothers was 24.7, with a standard deviation of
6.1, of which 23.6% were adolescents. The perception they had about their
oral health status was considered good by 60.8%. Of the 82.9% who reported
having attended dentistry, more than half perceived good oral health.
Pregnant women with no history of oral problems, with a perception of medium
or high income, and with good oral hygiene practices tend to have a good
perception of their oral health. Conclusion Pregnant women with no history of oral problems, with a perception of medium
or high income, and with good oral hygiene practices tend to have a good
perception of their oral health.
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Janssen LMM, Drost RMWA, Paulus ATG, Garfield K, Hollingworth W, Noble S, Thorn JC, Pokhilenko I, Evers SMAA. Aspects and Challenges of Resource Use Measurement in Health Economics: Towards a Comprehensive Measurement Framework. PHARMACOECONOMICS 2021; 39:983-993. [PMID: 34169466 PMCID: PMC8352823 DOI: 10.1007/s40273-021-01048-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND While the methods for conducting health economics research in general are improving, current guidelines provide limited guidance regarding resource use measurement (RUM). Consequently, a variety of methods exists, yet there is no overview of aspects to consider when deciding on the most appropriate RUM methodology. Therefore, this study aims to (1) identify and categorize existing knowledge regarding aspects of RUM, and (2) develop a framework that provides a comprehensive overview of methodological aspects regarding RUM. METHODS Relevant articles were identified by enrolling a search string in six databases and handsearching the DIRUM database. Included articles were descriptively reviewed and served as input for a comprehensive framework. Health economics experts were involved during the process to establish the framework's face validity. RESULTS Forty articles were included in the scoping review. The RUM framework consists of four methodological RUM domains: 'Whom to measure', addressing whom to ask and whom to measure; 'How to measure', addressing the different approaches of measurement; 'How often to measure', addressing recall period and measurement patterns; and 'Additional considerations', which covers additional aspects that are essential for further refining the methodologies for measurement. Evidence retrieved from the scoping review was categorized according to these domains. CONCLUSION This study clustered the aspects of RUM methodology in health economics into a comprehensive framework. The results may guide health economists in their decision making regarding the selection of appropriate RUM methods and developing instruments for RUM. Furthermore, policy makers may use these findings to review study results from an evidence-based perspective.
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Affiliation(s)
- Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands.
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Kirsty Garfield
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sian Noble
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre for Economic Evaluation and Machine Learning, Utrecht, The Netherlands
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Prevalence of Hypovitaminosis C and its Relationship with Frailty in Older Hospitalised Patients: A Cross-Sectional Study. Nutrients 2021; 13:nu13062117. [PMID: 34203044 PMCID: PMC8235098 DOI: 10.3390/nu13062117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/05/2022] Open
Abstract
Frailty is common in older hospitalised patients and may be associated with micronutrient malnutrition. Only limited studies have explored the relationship between frailty and vitamin C deficiency. This study investigated the prevalence of vitamin C deficiency and its association with frailty severity in patients ≥75 years admitted under a geriatric unit. Patients (n = 160) with a mean age of 84.4 ± 6.4 years were recruited and underwent frailty assessment by use of the Edmonton Frail Scale (EFS). Patients with an EFS score <10 were classified as non-frail/vulnerable/mildly frail and those with ≥10 as moderate–severely frail. Patients with vitamin C levels between 11–28 μmol/L were classified as vitamin C depleted while those with levels <11 μmol/L were classified as vitamin C deficient. A multivariate logistic regression model determined the relationship between vitamin C deficiency and frailty severity after adjustment for various co-variates. Fifty-seven (35.6%) patients were vitamin C depleted, while 42 (26.3%) had vitamin C deficiency. Vitamin C levels were significantly lower among patients who were moderate–severely frail when compared to those who were non-frail/vulnerable/mildly frail (p < 0.05). After adjusted analysis, vitamin C deficiency was 4.3-fold more likely to be associated with moderate–severe frailty (aOR 4.30, 95% CI 1.33-13.86, p = 0.015). Vitamin C deficiency is common and is associated with a greater severity of frailty in older hospitalised patients.
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Pérez-Aranda A, D'Amico F, Feliu-Soler A, McCracken LM, Peñarrubia-María MT, Andrés-Rodríguez L, Angarita-Osorio N, Knapp M, García-Campayo J, Luciano JV. Cost-Utility of Mindfulness-Based Stress Reduction for Fibromyalgia versus a Multicomponent Intervention and Usual Care: A 12-Month Randomized Controlled Trial (EUDAIMON Study). J Clin Med 2019; 8:jcm8071068. [PMID: 31330832 PMCID: PMC6678679 DOI: 10.3390/jcm8071068] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
Fibromyalgia (FM) is a prevalent, chronic, disabling, pain syndrome that implies high healthcare costs. Economic evaluations of potentially effective treatments for FM are needed. The aim of this study was to analyze the cost-utility of Mindfulness-Based Stress Reduction (MBSR) as an add-on to treatment-as-usual (TAU) for patients with FM compared to an adjuvant multicomponent intervention ("FibroQoL") and to TAU. We performed an economic evaluation alongside a 12 month, randomized, controlled trial; data from 204 (68 per study arm) of the 225 patients (90.1%) were included in the cost-utility analyses, which were conducted both under the government and the public healthcare system perspectives. The main outcome measures were the EuroQol (EQ-5D-5L) for assessing Quality-Adjusted Life Years (QALYs) and improvements in health-related quality of life, and the Client Service Receipt Inventory (CSRI) for estimating direct and indirect costs. Incremental cost-effectiveness ratios (ICERs) were also calculated. Two sensitivity analyses (intention-to-treat, ITT, and per protocol, PPA) were conducted. The results indicated that MBSR achieved a significant reduction in costs compared to the other study arms (p < 0.05 in the completers sample), especially in terms of indirect costs and primary healthcare services. It also produced a significant incremental effect compared to TAU in the ITT sample (ΔQALYs = 0.053, p < 0.05, where QALYs represents quality-adjusted life years). Overall, our findings support the efficiency of MBSR over FibroQoL and TAU specifically within a Spanish public healthcare context.
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Affiliation(s)
- Adrián Pérez-Aranda
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Clinical Psychology and Psychobiology (Section Personality, Assessment and Psychological Treatments), University of Barcelona, 08193 Barcelona, Spain
| | - Francesco D'Amico
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
| | - Albert Feliu-Soler
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
| | - Lance M McCracken
- Department of Psychology, Uppsala University, SE-751 05 Uppsala, Sweden
| | - María T Peñarrubia-María
- Primary Health Centre Bartomeu Fabrés Anglada, SAP Delta Llobregat, Unitat Docent Costa de Ponent, Institut Català de la Salut, 08850 Gavà, Spain
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
- Fundació IDIAP Jordi Gol I Gurina, 08007 Barcelona, Spain
| | - Laura Andrés-Rodríguez
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Natalia Angarita-Osorio
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain
| | - Martin Knapp
- The London School of Economics and Political Science (LSE), London WC2A 2AE, UK
- Centre for Biomedical Research in Epidemiology and Public Health, CIBERESP, 28029 Madrid, Spain
| | - Javier García-Campayo
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
- Department of Psychiatry, Miguel Servet Hospital, Aragon Institute of Health Sciences (I+CS), 50009 Zaragoza, Spain
| | - Juan V Luciano
- Group of Psychological Research in Fibromyalgia & Chronic Pain (AGORA), Institut de Recerca Sant Joan de Déu, 08950 Esplugues de Llobregat, Spain.
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain.
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain.
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Cislaghi B, Cislaghi C. Self-rated health as a valid indicator for health-equity analyses: evidence from the Italian health interview survey. BMC Public Health 2019; 19:533. [PMID: 31072306 PMCID: PMC6509759 DOI: 10.1186/s12889-019-6839-5] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Self-rated health is widely considered a good indicator of morbidity and mortality but its validity for health equity analysis and public health policies in Italy is often disregarded by policy-makers. This study had three objectives. O1: To explore response distribution across dimensions of age, chronic health conditions, functional limitations and SRH in Italy. O2: To explore associations between SRH and healthcare demand in Italy. O3: To explore the association between SRH and household income. METHODS Cross-sectional data were obtained from the 2015 Health Interview Survey (HIS) conducted in Italy. Italian respondents (n = 20,814) were included in logistic regression analyses. O1: associations of chronic health conditions (CHC), functional limitations (FL), and age with self-rated health (SRH) were tested. O2: associations of CHC, FL, and SRH with hospitalisation (H), medical specialist consultations (MSC), and medicine use (MU) were tested. O3: associations of SRH and CHC with household income (PEI) were tested. RESULTS O1: CHC, FL, and age had an independent summative effect on respondents' SRH. O2: SRH predicted H and MSC more than CHC; age and MU were more strongly correlated than SRH and MU. O3: SRH and PEI were significantly correlated, while we found no correlation between CHC and PEI. CONCLUSIONS Drawing from our results and the relevant literature, we suggest that policy-makers in Italy could use SRH measures to: 1) predict healthcare demand for effective allocation of resources; 2) assess subjective effectiveness of treatments; and 3) understand geosocial pockets of health inequity that require special attention.
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Affiliation(s)
- Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1 9SH, UK.
| | - Cesare Cislaghi
- Agenzia Nazionale per i Servizi Sanitari Regionali, Rome, Italy
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Dillon P, Smith SM, Gallagher P, Cousins G. The association between pharmacy refill-adherence metrics and healthcare utilisation: a prospective cohort study of older hypertensive adults. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 27:459-467. [PMID: 30968988 DOI: 10.1111/ijpp.12539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/26/2019] [Indexed: 11/26/2022]
Abstract
AIMS Methods that enable targeting and tailoring of adherence interventions may facilitate implementation in clinical settings. We aimed to determine whether community pharmacy refill-adherence metrics are useful to identify patients at higher risk of healthcare utilisation due to low antihypertensive adherence, who may benefit from an adherence intervention. METHODS We conducted a prospective cohort study, recruiting participants (n = 905) from 106 community pharmacies across the Republic of Ireland. Participants completed a structured interview at baseline and 12 months. Antihypertensive medication adherence was evaluated from linked pharmacy records using group-based trajectory modelling (GBTM) and proportion of days covered (PDC). Healthcare utilisation included self-reported number of hospital visits (emergency department visits and inpatient admissions) and general practitioner (GP) visits, over a 6-month period. Separate regression models were used to estimate the association between adherence and number of hospital/GP visits. The relative statistical fit of each model using different adherence metrics was determined using the Bayesian information criterion (BIC). RESULTS For the number of hospital visits, significant associations were observed only for PDC but not for GBTM. Each 10% increase in refill-adherence by PDC was significantly associated with a 16% lower rate of hospital visits (adjusted incidence rate ratio 0.84, 95% CI 0.72-0.98, P = 0.036). Poorer adherence using both measures was associated with higher GP visits. Improvements in BIC favoured models using PDC. CONCLUSIONS Medication refill-adherence, measured using PDC in community pharmacy settings, could be used to recognise poor antihypertensive adherence to enable effective targeting of clinical interventions to improve hypertension management and outcomes.
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Affiliation(s)
| | - Susan M Smith
- Department of General Practice, HRB Centre for Primary Care Research, RCSI, Dublin 2, Ireland
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Reho TTM, Atkins SA, Talola N, Sumanen MPT, Viljamaa M, Uitti J. Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland. BMJ Open 2019; 9:e024980. [PMID: 30782922 PMCID: PMC6411255 DOI: 10.1136/bmjopen-2018-024980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Frequent attenders (FAs) create a substantial portion of primary care workload but little is known about FAs' sickness absences. The aim of the study is to investigate how occasional and persistent frequent attendance is associated with sickness absences among the working population in occupational health (OH) primary care. SETTING AND PARTICIPANTS This is a longitudinal study using medical record data (2014-2016) from an OH care provider in Finland. In total, 59 676 patients were included and categorised into occasional and persistent FAs or non-FAs. Sick-leave episodes and their lengths were collected along with associated diagnostic codes. Logistic regression was used to analyse associations between FA status and sick leaves of different lengths (1-3, 4-14 and ≥15 days). RESULTS Both occasional and persistent FA had more and longer duration of sick leave than non-FA through the study years. Persistent FAs had consistently high absence rates. Occasional FAs had elevated absence rates even 2 years after their frequent attendance period. Persistent FAs (OR=11 95% CI 7.54 to 16.06 in 2016) and occasional FAs (OR=2.95 95% CI 2.50 to 3.49 in 2016) were associated with long (≥15 days) sickness absence when compared with non-FAs. Both groups of FAs had an increased risk of long-term sick leaves indicating a risk of disability pension. CONCLUSION Both occasional and persistent FAs should be identified in primary care units caring for working-age patients. As frequent attendance is associated with long sickness absences and possibly disability pensions, rehabilitation should be directed at this group to prevent work disability.
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Affiliation(s)
- Tiia T M Reho
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Pihlajalinna Työterveys, Tampere, Finland
| | - Salla A Atkins
- New Social Research and Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Nina Talola
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markku P T Sumanen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Jukka Uitti
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Finnish Institute of Occupational Health, Tampere, Finland
- Clinic of Occupational Medicine, Tampere University Hospital, Tampere, Finland
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Wallace E, Moriarty F, McGarrigle C, Smith SM, Kenny RA, Fahey T. Self-report versus electronic medical record recorded healthcare utilisation in older community-dwelling adults: Comparison of two prospective cohort studies. PLoS One 2018; 13:e0206201. [PMID: 30365518 PMCID: PMC6203362 DOI: 10.1371/journal.pone.0206201] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 10/09/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Self-reported measures of healthcare utilisation are often used in longitudinal cohort studies involving older community-dwelling people. The aim of this study is to compare healthcare utilisation rates using patient self-report and manual extraction from the general practice (GP) electronic medical record (EMR). METHODS Study population: Two prospective cohort studies (n = 806 and n = 1,377, aged ≥70 years) conducted in the Republic of Ireland were compared. Study outcomes: GP, outpatient department (OPD) and emergency department (ED) visits over a one-year period. Statistical analysis: Descriptive statistics of the two cohorts are presented. A negative binomial regression was performed and results are presented as incidence rate ratios (IRR) with 95% confidence intervals (CI). For the outcome of any ED visit, linear regression was performed, yielding risk ratios (RR) with 95% CI. RESULTS The annual rates of GP, OPD and ED visits were 6.30 (SD 4.63), 2.11 (SD 2.46) and 0.26 (SD 0.62) respectively in GP EMR cohort, compared to 5.65 (SD 8.06), 2.09 (SD 5.83) and 0.32 (SD 0.84) in the self-report cohort. In univariate regression analysis comparing healthcare utilisation, the self-report cohort reported a lower frequency of GP visits (unadjusted IRR 0.90 (95% CI 0.84, 0.96), p = 0.02)), a greater frequency of ED visits (1.20 (0.98, 1.49), p = 0.083)), and no difference in OPD visits (unadjusted IRR 0.99 (95% CI 0.86, 1.13), p = 0.845)). In multivariate analysis, adjusted for relevant confounders, there was no difference in GP visits (adjusted IRR 0.99 (95% CI 0.92, 1.06), p = 0.684)) or OPD visits (adjusted IRR 1.09 (0.95, 1.25), p = 0.23)) between the two cohorts. However, the self-report cohort reported 37% more ED visits (adjusted IRR 1.37 (1.10, 1.71), p = 0.005)) and were more likely to report any ED visit (adjusted RR 1.23 (95% CI 1.02, 1.48), p = 0.028)). CONCLUSIONS This study demonstrates that reported rates of GP and OPD visits were similar but there were differences in reported ED visits, with significantly higher self-reported visits. This may be due to ED visits not being notified to the GP and contextual issues such as transfer of healthcare utilisation data between sectors may vary in different healthcare systems.
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Affiliation(s)
- Emma Wallace
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
- * E-mail:
| | - Frank Moriarty
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
- The Irish Longitudinal Study of Ageing, Lincoln Gate, Trinity College Dublin, Dublin, Ireland
| | - Christine McGarrigle
- The Irish Longitudinal Study of Ageing, Lincoln Gate, Trinity College Dublin, Dublin, Ireland
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose-Anne Kenny
- The Irish Longitudinal Study of Ageing, Lincoln Gate, Trinity College Dublin, Dublin, Ireland
| | - Tom Fahey
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
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Rentz AM, Skalicky AM, Liu Z, Dunn DW, Frost MD, Nakagawa JA, Prestifilippo J, Said Q, Wheless JW. Burden of renal angiomyolipomas associated with tuberous sclerosis complex: results of a patient and caregiver survey. J Patient Rep Outcomes 2018; 2:30. [PMID: 30294710 PMCID: PMC6091699 DOI: 10.1186/s41687-018-0055-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Tuberous sclerosis complex (TSC) is a rare genetic disorder characterized by benign tumors in multiple organs, including non-cancerous kidney lesions known as renal angiomyolipomas. This study’s objective is to describe the age-stratified morbidity, treatment patterns, and health-related quality of life of TSC patients with renal angiomyolipomas in the United States. A cross-sectional, anonymous web-based survey was conducted with a convenience sample of TSC patients and caregivers identified through a patient advocacy organization. Results Out of the total sample of 676, 182 respondents reported having kidney complications with 33% of the pediatric group and 25% of the adult group with TSC reporting them. Of those with kidney complications, 110 (60%) reported a diagnosis of renal angiomyolipomas, of which 79 (72%) were adult patients and 31 (28%) were pediatric age patients. Eighty-four percent of the pediatric group and 76% of the adult group reported lesions on both kidneys. Of the patients experiencing involvement of only one kidney, 60% of the pediatric group and 21% of the adult group reported having multiple tumors within the affected kidney. Almost all of the sample (99%) reported seeing a physician and having a procedure or test for TSC in the past year. Less than half the respondents (44%) reported being hospitalized in the past year. Thirty-nine percent reported an emergency room visit as well. Compared to scores for patients with kidney disease, the angiomyolipoma adult patients reported significantly lower Mental Component Summary scores on the SF-12. Conclusions Renal angiomyolipomas burden leads to frequent healthcare resource use including hospitalization, invasive treatments, and surgical procedures, which result in an impaired mental health related quality of life.
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Affiliation(s)
- Anne M Rentz
- 1Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | - Anne M Skalicky
- 1Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD 20814 USA
| | | | - David W Dunn
- 3Riley Hospital for Children, Indianapolis, IN USA
| | | | | | | | | | - James W Wheless
- 6Le Bonheur Children's Hospital and the University of Tennessee, Memphis, TN USA
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Steventon A, Chaudhry SI, Lin Z, Mattera JA, Krumholz HM. Assessing the reliability of self-reported weight for the management of heart failure: application of fraud detection methods to a randomised trial of telemonitoring. BMC Med Inform Decis Mak 2017; 17:43. [PMID: 28420352 PMCID: PMC5395848 DOI: 10.1186/s12911-017-0426-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 03/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Since clinical management of heart failure relies on weights that are self-reported by the patient, errors in reporting will negatively impact the ability of health care professionals to offer timely and effective preventive care. Errors might often result from rounding, or more generally from individual preferences for numbers ending in certain digits, such as 0 or 5. We apply fraud detection methods to assess preferences for numbers ending in these digits in order to inform medical decision making. Methods The Telemonitoring to Improve Heart Failure Outcomes trial tested an approach to telemonitoring that used existing technology; intervention patients (n = 826) were asked to measure their weight daily using a digital scale and to relay measurements using their telephone keypads. First, we estimated the number of weights subject to end-digit preference by dividing the weights by five and comparing the resultant distribution with the uniform distribution. Then, we assessed the characteristics of patients reporting an excess number of weights ending in 0 or 5, adjusting for chance reporting of these values. Results Of the 114,867 weight readings reported during the trial, 18.6% were affected by end-digit preference, and the likelihood of these errors occurring increased with the number of days that had elapsed since trial enrolment (odds ratio per day: 1.002, p < 0.001). At least 105 patients demonstrated end-digit preference (14.9% of those who submitted data); although statistical significance was limited, a pattern emerged that, compared with other patients, they tended to be younger, male, high school graduates and on more medications. Patients with end-digit preference reported greater variability in weight, and they generated an average 2.9 alerts to the telemonitoring system over the six-month trial period (95% CI, 2.3 to 3.5), compared with 2.3 for other patients (95% CI, 2.2 to 2.5). Conclusions As well as overshadowing clinically meaningful changes in weight, end-digit preference can lead to false alerts to telemonitoring systems, which may be associated with unnecessary treatment and alert fatigue. In this trial, end-digit preference was common and became increasingly so over time. By applying fraud detection methods to electronic medical data, it is possible to produce clinically significant information that can inform the design of initiatives to improve the accuracy of reporting. Trial registration ClinicalTrials.gov registration number NCT00303212 March 2006.
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Affiliation(s)
- Adam Steventon
- Data Analytics, The Health Foundation, 90 Long Acre, London, WC2E 9RA, UK.
| | | | - Zhenqiu Lin
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
| | - Jennifer A Mattera
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, USA
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15
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Min JY, Park SG, Hwang SH, Min KB. Disparities in precarious workers' health care access in South Korea. Am J Ind Med 2016; 59:1136-1144. [PMID: 27699816 DOI: 10.1002/ajim.22658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND This study explored whether precarious workers have difficulties in health care access as compared with non-precarious workers. METHODS The 2008 Korean Community Health Survey data were used for this study. Information was obtained on 51,322 participants (40,514 non-precarious workers and 10,808 precarious workers). Precarious workers were defined as part-time or contingent workers. RESULTS Precarious workers had significantly higher risk of limited access to hospitals (OR = 1.14; 95% CI: 1.06-1.22) and dentists (OR = 1.28; 95% CI: 1.21-1.36) than non-precarious workers; disparities in doctor contacts among precarious workers were mostly linked to not having enough money. The risk of not receiving preventive care-medical checkups (OR = 0.52; 95% CI: 0.49-0.55) or cancer screenings (OR = 0.82; 95% CI: 0.77-0.86)-was also significantly elevated among precarious workers. CONCLUSION We found that precarious workers had more difficulty accessing health care or receiving health checkups or cancer screenings than their non-precarious counterparts. Am. J. Ind. Med. 59:1136-1144, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jin-Young Min
- Institute of Health and Environment; Seoul National University; Seoul Republic of Korea
| | - Shin-Goo Park
- Department of Occupational & Environmental Medicine; Inha University Hospital; Incheon Republic of Korea
| | - Sang Hee Hwang
- Department of Dentistry; Keimyung University School of Medicine; Dalseo-Gu Daegu Republic of Korea
| | - Kyoung-Bok Min
- Department of Preventive Medicine; College of Medicine; Seoul National University; Seoul Republic of Korea
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16
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Cutajar R, Roberts A. The Relationship between Engagement in Occupations and Pressure Sore Development in Saudi Men with Paraplegia. Br J Occup Ther 2016. [DOI: 10.1177/030802260506800704] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Various research studies have explored the factors that predispose people with spinal cord injuries to pressure sore development. Two hundred risk factors have been associated with pressure sore occurrence. One of the variables commonly reported to affect pressure sore occurrence is a decreased level of activity (Vidal and Sarrias 1991, Fuhrer et al 1993). This concurs with the philosophy of occupational therapy that a reduction in activity can generate pathology (Miller et al 1988). This research study investigated whether decreased participation in occupational activities (work, leisure and activities of daily living) was related to pressure sore occurrence in paraplegic men. The sample was selected randomly from the occupational therapy discharge files of a rehabilitation facility in Saudi Arabia. The data were collected by means of a telephone questionnaire from a total of 58 men, over a 3-month period. The study showed that there was a large increase in unemployment in paraplegic men following injury (from 10% to 59%) and, as might be expected, manual workers were more vulnerable than office workers. The study found no significant association between pressure sore occurrence and whether or not the individual was employed. However, it showed a statistically significant association between unemployment and pressure sores severe enough to lead to hospitalisation. The study also found a statistically significant association between individuals' independence in activities of daily living and the number of pressure sores that they had reported in the last 2 years. These findings indicate the potential importance of clients remaining occupationally active for their wellbeing and the significant contribution that occupational therapists can make by enabling rehabilitation of occupational activities.
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Icks A, Dittrich A, Brüne M, Kuss O, Hoyer A, Haastert B, Begun A, Andrich S, Hoffmann J, Kaltheuner M, Chernyak N. Agreement found between self-reported and health insurance data on physician visits comparing different recall lengths. J Clin Epidemiol 2016; 82:167-172. [PMID: 27825891 DOI: 10.1016/j.jclinepi.2016.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 10/12/2016] [Accepted: 10/28/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the impact of different recall lengths on agreement between self-reported physician visits and those documented in health insurance data applying an experimental design. STUDY DESIGN AND SETTING We randomly assigned 432 patients with diabetes to one of two versions of a written survey, each asking about the number of physician visits over a 3- or 6-month recall period. Health insurance data were linked individually. RESULTS In both groups, the mean number of self-reported physician visits per month was lower than in the insurance data, with a larger difference in the 6-month group (-0.9; 95% CI -1.0, -0.7) than in the 3-month group (-0.5; -0.7; -0.2), difference between the two groups: 0.4 (0.1-0.7; P = 0.009). The percentage of participants with correct reporting was small and did not differ largely between the two groups (6.5% and 9.3%). However, there was more overreporting in the 3-month group (25.6% vs. 11.1%). CONCLUSIONS Shorter recall periods may produce more accurate results when estimating the mean number of physician visits. However, this may be driven not by a more accurate reporting, but by a higher proportion of respondents that overreported and a lower proportion of respondents that underreported, when compared to the longer reporting period.
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Affiliation(s)
- Andrea Icks
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraβe 5, 40225 Düsseldorf, Germany; Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraβe 1, 85764 Neuherberg, Germany.
| | - Alexandra Dittrich
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraβe 5, 40225 Düsseldorf, Germany
| | - Manuela Brüne
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Oliver Kuss
- German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Ingolstädter Landstraβe 1, 85764 Neuherberg, Germany; Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Moorenstraβe 5, 40225 Düsseldorf, Germany
| | - Annika Hoyer
- German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Burkhard Haastert
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraβe 5, 40225 Düsseldorf, Germany; mediStatistica, Lambertusweg 1, 58809 Neuenrade, Germany
| | - Alexander Begun
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Silke Andrich
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraβe 5, 40225 Düsseldorf, Germany; Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Jonas Hoffmann
- Paul Langerhans Group of Health Services Research and Health Economics, German Diabetes Center, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany; German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich-Heine-University Düsseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany
| | - Matthias Kaltheuner
- Specialised Diabetes Practice Leverkusen, Kalkstraβe 117, 51377 Leverkusen, Germany
| | - Nadja Chernyak
- Institute of Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine University Düsseldorf, Moorenstraβe 5, 40225 Düsseldorf, Germany
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Van der Heyden J, Charafeddine R, De Bacquer D, Tafforeau J, Van Herck K. Regional differences in the validity of self-reported use of health care in Belgium: selection versus reporting bias. BMC Med Res Methodol 2016; 16:98. [PMID: 27528010 PMCID: PMC4986374 DOI: 10.1186/s12874-016-0198-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/28/2016] [Indexed: 11/24/2022] Open
Abstract
Background The Health Care Module of the European Health Interview Survey (EHIS) is aimed to obtain comparable information on the use of inpatient and ambulatory care in all EU member states. In this study we assessed the validity of self-reported information on the use of health care, collected through this instrument, in the Belgian Health Interview Survey (BHIS), and explored the impact of selection and reporting bias on the validity of regional differences in health care use observed in the BHIS. Methods To assess reporting bias, self-reported BHIS 2008 data were linked with register-based data from the Belgian compulsory health insurance (BCHI). The latter were compared with similar estimates from a random sample of the BCHI to investigate the selection bias. Outcome indicators included the prevalence of a contact with a GP, specialist, dentist and a physiotherapist, as well as inpatient and day patient hospitalisation. The validity of the estimates and the regional differences were explored through measures of agreement and logistic regression analyses. Results Validity of self-reported health care use varies by type of health service and is more affected by reporting than by selection bias. Compared to health insurance estimates, self-reported results underestimate the percentage of people with a specialist contact in the past year (50.5 % versus 65.0 %) and a day patient hospitalisation (7.8 % versus 13.9 %). Inversely, survey results overestimated the percentage of people having visited a dentist in the past year: 58.3 % versus 48.6 %. The best concordance was obtained for an inpatient hospitalisation (kappa 0.75). Survey data overestimate the higher prevalence of a contact with a specialist [OR 1.51 (95 % CI 1.33–1.72) for self-report and 1.08 (95 % CI 1.05–1.15) for register] and underestimate the lower prevalence of a contact with a GP [ORs 0.59 (95 % CI 0.51–0.70) and 0.41 (95 % CI 0.39–0.42) respectively] in Brussels compared to Flanders. Conclusion Cautiousness is needed to interpret self-reported use of health care, especially for ambulatory care. Regional differences in self-reported health care use may be influenced by regional differences in the validity of the self-reported information. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0198-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Van der Heyden
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium.
| | - R Charafeddine
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - D De Bacquer
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
| | - J Tafforeau
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium
| | - K Van Herck
- Department of Public Health, Ghent University, 185, De Pintelaan, 9000, Ghent, Belgium
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Schmitz MF, Russell DW, Cutrona CE. The Validity of Self-Reports of Physician Use Among the Older Population. J Appl Gerontol 2016. [DOI: 10.1177/07364802021002005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study assessed the validity of older person self-reports of doctor visits, examining variation in the validity of these reports due to factors commonly used in models of health service use. Data were from a sample of 215 healthy, community-dwelling older persons. Participantswere interviewed three times in person at 6-month intervals. They also completed brief mail questionnaires each month between the personal interviews. Information about physical health status and health service use was obtained from the participants' personal physicians. One-way ANOVA tests of means and multinomial logit analyses indicated those respondents reporting more physician visits were significantly less likely to report the same number of visits as the doctors reported and were more likely to underreport than overreport the number of visits. Among the nonsignificant relationships with reporting style were several measures of health status. Implications of recall period length on the validity of these reports are discussed.
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Fujita M, Sato Y, Nagashima K, Takahashi S, Hata A. Validity assessment of self-reported medication use by comparing to pharmacy insurance claims. BMJ Open 2015; 5:e009490. [PMID: 26553839 PMCID: PMC4654279 DOI: 10.1136/bmjopen-2015-009490] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES In Japan, an annual health check-up and health promotion guidance programme was established in 2008 in accordance with the Act on Assurance of Medical Care for the Elderly. A self-reported questionnaire on medication use is a required item in this programme and has been used widely, but its validity has not been assessed. The aim of this study was to evaluate the validity of this questionnaire by comparing self-reported usage to pharmacy insurance claims. SETTING This is a population-based validation study. Self-reported medication use for hypertension, diabetes and dyslipidaemia is the evaluated measurement. Data on pharmacy insurance claims are used as a reference standard. PARTICIPANTS Participants were 54,712 beneficiaries of the National Health Insurance of Chiba City. PRIMARY AND SECONDARY OUTCOME MEASURES Sensitivity, specificity and κ statistics of the self-reported medication-use questionnaire for predicting actual prescriptions during 1 month (that of the check-up) and 3 months (that of the check-up and the previous 2 months) were calculated. RESULTS Sensitivity and specificity scores of questionnaire data for predicting insurance claims covering 3 months were, respectively, 92.4% (95% CI 91.9 to 92.8) and 86.4% (95% CI 86.0 to 86.7) for hypertension, 82.6% (95% CI 81.1 to 84.0) and 98.5% (95% CI 98.4 to 98.6) for diabetes, and 86.2% (95% CI 85.5 to 86.8) and 91.0% (95% CI 90.8 to 91.3) for dyslipidaemia. Corresponding κ statistics were 70.9% (95% CI 70.1 to 71.7), 77.1% (95% CI 76.2 to 77.9) and 69.8% (95% CI 68.9 to 70.6). The specificity was significantly higher for questionnaire data covering 3 months compared with data covering 1 month for all 3 conditions. CONCLUSIONS Self-reported questionnaire data on medication use had sufficiently high validity for further analyses. Item responses showed close agreement with actual prescriptions, particularly those covering 3 months.
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Affiliation(s)
- Misuzu Fujita
- Department of Public Health, Chiba University, Chiba, Japan
| | - Yasunori Sato
- Department of Global Clinical Research, Chiba University, Chiba, Japan
- Chiba University Hospital, Clinical Research Center, Chiba, Japan
| | - Kengo Nagashima
- Department of Global Clinical Research, Chiba University, Chiba, Japan
- Chiba University Hospital, Clinical Research Center, Chiba, Japan
| | - Sho Takahashi
- Chiba University Hospital, Clinical Research Center, Chiba, Japan
| | - Akira Hata
- Department of Public Health, Chiba University, Chiba, Japan
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Szalda D, Pierce L, Hobbie W, Ginsberg JP, Brumley L, Wasik M, Li Y, Schwartz LA. Engagement and experience with cancer-related follow-up care among young adult survivors of childhood cancer after transfer to adult care. J Cancer Surviv 2015; 10:342-50. [DOI: 10.1007/s11764-015-0480-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022]
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Houweling T, Bolton J, Newell D. Comparison of two methods of collecting healthcare usage data in chiropractic clinics: patient-report versus documentation in patient files. Chiropr Man Therap 2014; 22:32. [PMID: 25309721 PMCID: PMC4193989 DOI: 10.1186/s12998-014-0032-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022] Open
Abstract
Background The use of patient-reported questionnaires to collect information on costs associated with routine healthcare services, such as chiropractic, represents a less labour intensive alternative to retrieving these data from patient files. The aim of this paper was to compare patient-report versus patient files for the collection of data describing healthcare usage in chiropractic clinics. Methods As part of a prospective single cohort multi-centre study, data on the number of visits made to chiropractic clinics determined using patient-reported questionnaires or as recorded in patient files were compared three months following the start of treatment. These data were analysed for agreement using the Intraclass Correlation Coefficient (ICC) and the 95% Limits of Agreement. Results Eighty-nine patients that had undergone chiropractic care were included in the present study. The two methods yielded an ICC of 0.83 (95% CI = 0.75 to 0.88). However, there was a significant difference between the data collection methods, with an average of 0.6 (95% CI = 0.25 to 1.01) additional visits reported in patient files. The 95% Limits of Agreement ranged from 3 fewer visits to 4 additional visits in patient files relative to the number of visits recalled by patients. Conclusion There was some discrepancy between the number of visits made to the clinic recalled by patients compared to the number recorded in patient files. This should be taken into account in future evaluations of costs of treatments.
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Affiliation(s)
- Taco Houweling
- University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Jennifer Bolton
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
| | - David Newell
- Anglo-European College of Chiropractic, 13-15 Parkwood Road, Bournemouth, BH5 2DF UK
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van Dalen MT, Suijker JJ, MacNeil-Vroomen J, van Rijn M, Moll van Charante EP, de Rooij SE, Buurman BM. Self-report of healthcare utilization among community-dwelling older persons: a prospective cohort study. PLoS One 2014; 9:e93372. [PMID: 24710075 PMCID: PMC3977826 DOI: 10.1371/journal.pone.0093372] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 03/04/2014] [Indexed: 12/04/2022] Open
Abstract
Background Self-reported data are often used for estimates on healthcare utilization in cost-effectiveness studies. Objective To analyze older adults’ self-report of healthcare utilization compared to data obtained from the general practitioners’ (GP) electronic medical record (EMR) and to study the differences in healthcare utilization between those who completed the study, those who did not respond, and those lost to follow-up. Methods A prospective cohort study was conducted among community-dwelling persons aged 70 years and above, without dementia and not living in a nursing home. Self-reporting questionnaires were compared to healthcare utilization data extracted from the EMR at the GP-office. Results Overall, 790 persons completed questionnaires at baseline, median age 75 years (IQR 72–80), 55.8% had no disabilities in (instrumental) activities of daily living. Correlations between self-report data and EMR data on healthcare utilization were substantial for ‘hospitalizations’ and ‘GP home visits’ at 12 months intraclass correlation coefficient 0.63 (95% CI; 0.58–0.68). Compared to the EMR, self-reported healthcare utilization was generally slightly over-reported. Non-respondents received more GP home visits (p<0.05). Of the participants who died or were institutionalized 62.2% received 2 or more home visits (p<0.001) and 18.9% had 2 or more hospital admissions (p<0.001) versus respectively 18.6% and 3.9% of the participants who completed the study. Of the participants lost to follow-up for other reasons 33.0% received 2 or more home visits (p<0.01) versus 18.6 of the participants who completed the study. Conclusions Self-report of hospitalizations and GP home visits in a broadly ‘healthy’ community-dwelling older population seems adequate and efficient. However, as people become older and more functionally impaired, collecting healthcare utilization data from the EMR should be considered to avoid measurement bias, particularly if the data will be used to support economic evaluation.
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Affiliation(s)
- Marlies T. van Dalen
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline J. Suijker
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Janet MacNeil-Vroomen
- Department of Internal medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjon van Rijn
- Department of Internal medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric P. Moll van Charante
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophia E. de Rooij
- Department of Internal medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Bianca M. Buurman
- Department of Internal medicine, Geriatric section, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial. BMC Health Serv Res 2013; 13:395. [PMID: 24099334 PMCID: PMC3852608 DOI: 10.1186/1472-6963-13-395] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/30/2013] [Indexed: 11/20/2022] Open
Abstract
Background Telehealth is increasingly used in the care of people with long term conditions. Whilst many studies look at the impacts of the technology on hospital use, few look at how it changes contacts with primary care professionals. The aim of this paper was to assess the impacts of home-based telehealth interventions on general practice contacts. Method Secondary analysis of data from a Department of Health funded cluster-randomised trial with 179 general practices in three areas of England randomly assigned to offer telehealth or usual care to eligible patients. Telehealth included remote exchange of vitals signs and symptoms data between patients and healthcare professionals as part of the continuing management of patients. Usual care reflected the range of services otherwise available in the sites, excluding telehealth. Anonymised data from GP systems were used to construct person level histories for control and intervention patients. We tested for differences in numbers of general practitioner and practice nurse contacts over twelve months and in the number of clinical readings recorded on general practice systems over twelve months. Results 3,230 people with diabetes, chronic obstructive pulmonary disease or heart failure were recruited in 2008 and 2009. 1219 intervention and 1098 control cases were available for analysis. No statistically significant differences were detected in the numbers of general practitioner or practice nurse contacts between intervention and control groups during the trial, or in the numbers of clinical readings recorded on the general practice systems. Conclusions Telehealth did not appear associated with different levels of contact with general practitioners and practice nurses. We note that the way that telehealth impacts on primary care roles may be influenced by a number of other features in the health system. The challenge is to ensure that these systems lead to better integration of care than fragmentation. Trial registration number International Standard Randomised Controlled Trial Number Register ISRCTN43002091.
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Peersman W, Pasteels I, Cambier D, De Maeseneer J, Willems S. Validity of self-reported utilization of physician services: a population study. Eur J Public Health 2013; 24:91-7. [PMID: 23813707 DOI: 10.1093/eurpub/ckt079] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Health care utilization is of central interest in epidemiology, and most of the studies rely on self-report. The objectives of this study were to assess the validity of self-reported utilization of general practitioner and specialist physician by correlating self-reported utilization with registered services utilization, and to determine the factors related to that validity. METHODS The 1997 Belgian National Health Interview Survey (BNHIS) was linked with registered medical utilization data provided by the Belgian Health Insurance Funds. Valid information on general practitioner and specialist physician utilization during the past 2 months was found for 5869 participants at the BNHIS who were aged ≥25 years. Intra-class correlation coefficients were used to determine the rate of agreement, and multinomial logistic regression to model factors influencing under- and over-reporting. RESULTS The results demonstrated a substantial agreement between the self-reported and registered general practitioner contacts, and only a minor bias was found towards under-reporting. There was no significant difference between mean self-reported and registered specialist physician utilization, but the agreement was rather moderate. Gender, age, country of birth, self-rated health, number of chronic illnesses, having functional limitations and having mental health problems, were associated with under- and/or over-reporting. CONCLUSION Studies that aim to compare the utilization of different socio-demographic groups have to take into account that the reporting errors vary by respondents characteristics.
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Affiliation(s)
- Wim Peersman
- 1 Department of Family Medicine and Primary Health Care, Ghent University, Campus Heymans - 6K3, De Pintelaan 185, 9000 Gent, Belgium
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Chishti T, Harris T, Conroy R, Oakeshott P, Tulloch J, Coster D, Kerry SR, Kerry SM. How reliable are stroke patients' reports of their numbers of general practice consultations over 12 months? Fam Pract 2013; 30:119-22. [PMID: 22987457 DOI: 10.1093/fampra/cms042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data on primary health care use are frequently used in economic evaluations. However, it is unclear how patient self-reports of their number of consultations with their general practitioner (GP) relate to actual consultations in the electronic records. These data are crucial if self-reports are used to conduct economic evaluations. OBJECTIVES To report the accuracy of stroke patients' self-reports of their number of primary care consultations over a 12-month period by comparison with practice-held electronic records. We also recorded the number of contacts required to collect service use data from the practices. METHODS We contacted 65 practices requesting electronic consultation records over 12 months for 115 stroke patients who took part in a trial of home blood pressure monitoring. Consultation rates from the electronic records were compared with patients' self-reported number of consultations from a questionnaire covering the same period. RESULTS Fifty-one practices (78%) responded. Patients' questionnaires (n = 83) reported a mean of 5.7 consultations with their GP per year compared with 7.2 in the electronic records (difference 1.6, 95% confidence interval 0.5-2.7, P < 0.01). The mean time taken to obtain records from practices was 6 weeks. CONCLUSIONS Patients modestly under-reported the number of consultations they had with a GP. Obtaining patient records from practices required more effort than obtaining information from patient questionnaires at the same time as assessing main trial outcomes. If patient self-reports of health care usage are used in economic evaluations in primary care, researchers should consider validating a sample against electronic records.
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Affiliation(s)
- Tahira Chishti
- London School of Medicine and Dentistry, University of London, London, UK
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Patel MR, Valerio MA, Janevic MR, Gong ZM, Sanders G, Thomas LJ, Clark NM. Long-term effects of negotiated treatment plans on self-management behaviors and satisfaction with care among women with asthma. J Asthma 2013; 50:82-9. [PMID: 23189924 PMCID: PMC3617926 DOI: 10.3109/02770903.2012.743151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine characteristics of women with negotiated treatment plans, factors that contribute to newly forming a treatment plan, and the impact of plans on asthma management, and their satisfaction with care over 2 years. METHODS Data came from telephone interviews with 324 women with asthma at baseline, 12 and 24 months. The effect of having a negotiated treatment plan on medication adherence, asking the physician questions about asthma, asthma management self-efficacy, and satisfaction with care was assessed over 24 months. Data were analyzed using mixed models. Analyses controlled for patient characteristics. RESULTS Thirty-eight percent of participants reported having a negotiated treatment plan at three time points. Seeing an asthma specialist (χ(2)(1) = 24.07, p < .001), was associated with having a plan. Women who did not have a negotiated treatment plan at baseline, but acquired one at 12 or 24 months, were more likely to report greater urgent office visits for asthma (odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.07-1.61). No associations were observed between having a plan and urgent healthcare use or symptom frequency. When adjusting for household income, level of asthma control, and specialty of the caregiving provider, women who did not have a negotiated treatment plan (OR = 0.28, 95% CI = 0.09-0.79) and those with a plan at fewer than three time points (OR = 0.30, 95% CI = 0.11-0.83) were less likely to report medication adherence and satisfaction with their care (regression coefficient (standard error) = -0.65 (0.17), p < .001). No differences in asthma management self-efficacy or asking the doctor questions about asthma were observed. CONCLUSION Women with asthma who had a negotiated treatment plan were more likely to see an asthma specialist. In the long-term, not having a treatment plan that is developed in partnership with a clinician may have an adverse impact on medication use and patient views of clinical services.
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Affiliation(s)
- Minal R Patel
- Center for Managing Chronic Disease, University of Michigan, Ann Arbor, MI 48109-2029, USA
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Willet MN, Hayes DK, Zaha RL, Fuddy LJ. Social-emotional support, life satisfaction, and mental health on reproductive age women's health utilization, US, 2009. Matern Child Health J 2012; 16 Suppl 2:203-12. [PMID: 22956364 PMCID: PMC4545528 DOI: 10.1007/s10995-012-1096-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
To examine the associations among social-emotional support, life satisfaction, and mental health with not having a routine checkup among women of reproductive age in the US, data from the 2009 Behavioral Risk Factor Surveillance System, a population-based telephone survey of health behaviors, were analyzed among reproductive aged (18-44 years) women in the US. Prevalence estimates were calculated for not having a routine checkup in the past year with measures of social-emotional support, life satisfaction, and mental distress. Independent multivariable logistic regressions for each measure assessed not having a routine checkup within the past year with adjustment for age, race/ethnicity, education level, and health care coverage. Among women of reproductive age, 33.7 % (95 % CI 33.0-34.4) did not have a routine checkup within the past year. Factors associated with not having a routine checkup included: having social-emotional support most of the time (AOR = 1.29, 95 % CI 1.20-1.38) or sometimes or less (AOR = 1.47, 95 % CI 1.34-1.61) compared to those who reported always having the social-emotional support they need; reporting life satisfaction as being satisfied (AOR = 1.27, 95 % CI 1.19-1.36) or dissatisfied (AOR = 1.65, 95 % CI 1.43-1.91) compared to being very satisfied; and frequent mental distress (AOR = 1.19, 95 % CI 1.09-1.30) compared to those without. Women who report lower levels of social-emotional support, less life satisfaction, and frequent mental distress are less likely to see a doctor for a routine checkup. Targeted outreach that provides appropriate support are needed so these women can access clinical services to increase exposure to preventive health opportunities and improve overall health.
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Affiliation(s)
- Michelle N. Willet
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA
| | - Donald K. Hayes
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA,
| | - Rebecca L. Zaha
- Family Health Services Division, Hawaii State Department of Health, 3652 Kilauea Avenue, Honolulu, HI 96816, USA
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Lankila T, Näyhä S, Rautio A, Koiranen M, Rusanen J, Taanila A. Health and well-being of movers in rural and urban areas--a grid-based analysis of northern Finland birth cohort 1966. Soc Sci Med 2012; 76:169-78. [PMID: 23159306 DOI: 10.1016/j.socscimed.2012.10.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 09/12/2012] [Accepted: 10/25/2012] [Indexed: 11/27/2022]
Abstract
We examined the association of health and well-being with moving using a detailed geographical scale. 7845 men and women born in northern Finland in 1966 were surveyed by postal questionnaire in 1997 and linked to 1 km(2) geographical grids based on each subject's home address in 1997-2000. Population density was used to classify each grid as rural (1-100 inhabitants/km²) or urban (>100 inhabitants/km²) type. Moving was treated as a three-class response variate (not moved; moved to different type of grid; moved to similar type of grid). Moving was regressed on five explanatory factors (life satisfaction, self-reported health, lifetime morbidity, activity-limiting illness and use of health services), adjusting for factors potentially associated with health and moving (gender, marital status, having children, housing tenure, education, employment status and previous move). The results were expressed as odds ratios (OR) and their 95% confidence intervals (CI). Moves from rural to urban grids were associated with dissatisfaction with current life (adjusted OR 2.01; 95% CI 1.26-3.22) and having somatic (OR 1.66; 1.07-2.59) or psychiatric (OR 2.37; 1.21-4.63) morbidities, the corresponding ORs for moves from rural to other rural grids being 1.71 (0.98-2.98), 1.63 (0.95-2.78) and 2.09 (0.93-4.70), respectively. Among urban dwellers, only the frequent use of health services (≥ 21 times/year) was associated with moving, the adjusted ORs being 1.65 (1.05-2.57) for moves from urban to rural grids and 1.30 (1.03-1.64) for urban to other urban grids. We conclude that dissatisfaction with life and history of diseases and injuries, especially psychiatric morbidity, may increase the propensity to move from rural to urbanised environments, while availability of health services may contribute to moves within urban areas and also to moves from urban areas to the countryside, where high-level health services enable a good quality of life for those attracted by the pastoral environment.
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Affiliation(s)
- Tiina Lankila
- Department of Geography, University of Oulu, Finland; Institute of Health Sciences, University of Oulu, Oulu, Finland.
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Steventon A, Roberts A. Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets. BMC Health Serv Res 2012; 12:377. [PMID: 23110445 PMCID: PMC3537534 DOI: 10.1186/1472-6963-12-377] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 10/24/2012] [Indexed: 12/02/2022] Open
Abstract
Background Information about how long people stay in care homes is needed to plan services, as length of stay is a determinant of future demand for care. As length of stay is proportional to cost, estimates are also needed to inform analysis of the long-term cost effectiveness of interventions aimed at preventing admissions to care homes. But estimates are rarely available due to the cost of repeatedly surveying individuals. Methods We used administrative data from three local authorities in England to estimate the length of publicly-funded care homes stays beginning in 2005 and 2006. Stays were classified into nursing home, permanent residential and temporary residential. We aggregated successive placements in different care home providers and, by linking to health data, across periods in hospital. Results The largest group of stays (38.9%) were those intended to be temporary, such as for rehabilitation, and typically lasted 4 weeks. For people admitted to permanent residential care, median length of stay was 17.9 months. Women stayed longer than men, while stays were shorter if preceded by other forms of social care. There was significant variation in length of stay between the three local authorities. The typical person admitted to a permanent residential care home will cost a local authority over £38,000, less payments due from individuals under the means test. Conclusions These figures are not apparent from existing data sets. The large cost of care home placements suggests significant scope for preventive approaches. The administrative data revealed complexity in patterns of service use, which should be further explored as it may challenge the assumptions that are often made.
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Affiliation(s)
- Adam Steventon
- The Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK.
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Steventon A, Bardsley M, Billings J, Georghiou T, Lewis GH. The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation. Health Serv Res 2012; 47:1679-98. [PMID: 22224902 PMCID: PMC3401405 DOI: 10.1111/j.1475-6773.2011.01367.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams." DATA SOURCES/STUDY SETTING Linked administrative data for England covering the period 2004 to 2009. STUDY DESIGN This study was commissioned after the interventions had been in place for several years. We developed a method based on retrospective analysis of person-level data comparing health care use of participants with that of prognostically matched controls. DATA COLLECTION/EXTRACTION METHODS Individuals were linked to administrative datasets through a trusted intermediary and a unique patient identifier. PRINCIPAL FINDINGS Participants who received the intermediate care intervention showed higher rates of unscheduled hospital admission than matched controls, whereas recipients of the integrated care team intervention showed no difference. Both intervention groups showed higher rates of mortality than did their matched controls. CONCLUSIONS These are potentially powerful techniques for assessing impacts on hospital activity. Neither intervention reduced admission rates. Although our analysis of hospital utilization controlled for a wide range of observable characteristics, the difference in mortality rates suggests that some residual confounding is likely. Evaluation is constrained when performed retrospectively, and careful interpretation is needed.
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Palmer L, Johnston SS, Rousculp MD, Chu BC, Nichol KL, Mahadevia PJ. Agreement between Internet-based self- and proxy-reported health care resource utilization and administrative health care claims. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2012; 15:458-465. [PMID: 22583456 DOI: 10.1016/j.jval.2011.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 12/09/2011] [Accepted: 12/12/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Although Internet-based surveys are becoming more common, little is known about agreement between administrative claims data and Internet-based survey self- and proxy-reported health care resource utilization (HCRU) data. This analysis evaluated the level of agreement between self- and proxy-reported HCRU data, as recorded through an Internet-based survey, and administrative claims-based HCRU data. METHODS The Child and Household Influenza-Illness and Employee Function study collected self- and proxy-reported HCRU data monthly between November 2007 and May 2008. Data included the occurrence and number of visits to hospitals, emergency departments, urgent care centers, and outpatient offices for a respondent's and his or her household members' care. Administrative claims data from the MarketScan® Databases were assessed during the same time and evaluated relative to survey-based metrics. Only data for individuals with employer-sponsored health care coverage linkable to claims were included. The Kappa (κ) statistic was used to evaluate visit concordance, and the intraclass correlation coefficient was used to describe frequency consistency. RESULTS Agreement for presence of a health care visit and the number of visits were similar for self- and proxy-reported HCRU data. There was moderate to substantial agreement related to health care visit occurrence between survey-based and claims-based HCRU data for inpatient, emergency department, and office visits (κ: 0.47-0.77). There was less agreement on health care visit frequencies, with intraclass correlation coefficient values ranging from 0.14 to 0.71. CONCLUSIONS This study's agreement values suggest that Internet-based surveys are an effective method to collect self- and proxy-reported HCRU data. These results should increase confidence in the use of the Internet for evaluating disease burden.
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Affiliation(s)
- Liisa Palmer
- Thomson Reuters, Outcomes Research, Washington, DC, USA
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Billings J, Blunt I, Steventon A, Georghiou T, Lewis G, Bardsley M. Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30). BMJ Open 2012; 2:bmjopen-2012-001667. [PMID: 22885591 PMCID: PMC3425907 DOI: 10.1136/bmjopen-2012-001667] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To develop an algorithm for identifying inpatients at high risk of re-admission to a National Health Service (NHS) hospital in England within 30 days of discharge using information that can either be obtained from hospital information systems or from the patient and their notes. DESIGN Multivariate statistical analysis of routinely collected hospital episode statistics (HES) data using logistic regression to build the predictive model. The model's performance was calculated using bootstrapping. SETTING HES data covering all NHS hospital admissions in England. PARTICIPANTS The NHS patients were admitted to hospital between April 2008 and March 2009 (10% sample of all admissions, n=576 868). MAIN OUTCOME MEASURES Area under the receiver operating characteristic curve for the algorithm, together with its positive predictive value and sensitivity for a range of risk score thresholds. RESULTS The algorithm produces a 'risk score' ranging (0-1) for each admitted patient, and the percentage of patients with a re-admission within 30 days and the mean re-admission costs of all patients are provided for 20 risk bands. At a risk score threshold of 0.5, the positive predictive value (ie, percentage of inpatients identified as high risk who were subsequently re-admitted within 30 days) was 59.2% (95% CI 58.0% to 60.5%); representing 5.4% (95% CI 5.2% to 5.6%) of all inpatients who would be re-admitted within 30 days (sensitivity). The area under the receiver operating characteristic curve was 0.70 (95% CI 0.69 to 0.70). CONCLUSIONS We have developed a method of identifying inpatients at high risk of unplanned re-admission to NHS hospitals within 30 days of discharge. Though the models had a low sensitivity, we show how to identify subgroups of patients that contain a high proportion of patients who will be re-admitted within 30 days. Additional work is necessary to validate the model in practice.
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Affiliation(s)
- John Billings
- Robert F. Wagner Graduate School of Public Service, New York University, New York, USA
| | | | | | | | - Geraint Lewis
- Department of Clinical Outcomes & Analytics, Walgreen Co., Deerfield, Illinois, USA
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Bower P, Cartwright M, Hirani SP, Barlow J, Hendy J, Knapp M, Henderson C, Rogers A, Sanders C, Bardsley M, Steventon A, Fitzpatrick R, Doll H, Newman S. A comprehensive evaluation of the impact of telemonitoring in patients with long-term conditions and social care needs: protocol for the whole systems demonstrator cluster randomised trial. BMC Health Serv Res 2011; 11:184. [PMID: 21819569 PMCID: PMC3169462 DOI: 10.1186/1472-6963-11-184] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 08/05/2011] [Indexed: 11/10/2022] Open
Abstract
Background It is expected that increased demands on services will result from expanding numbers of older people with long-term conditions and social care needs. There is significant interest in the potential for technology to reduce utilisation of health services in these patient populations, including telecare (the remote, automatic and passive monitoring of changes in an individual's condition or lifestyle) and telehealth (the remote exchange of data between a patient and health care professional). The potential of telehealth and telecare technology to improve care and reduce costs is limited by a lack of rigorous evidence of actual impact. Methods/Design We are conducting a large scale, multi-site study of the implementation, impact and acceptability of these new technologies. A major part of the evaluation is a cluster-randomised controlled trial of telehealth and telecare versus usual care in patients with long-term conditions or social care needs. The trial involves a number of outcomes, including health care utilisation and quality of life. We describe the broad evaluation and the methods of the cluster randomised trial Discussion If telehealth and telecare technology proves effective, it will provide additional options for health services worldwide to deliver care for populations with high levels of need. Trial Registration Current Controlled Trials ISRCTN43002091
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Affiliation(s)
- Peter Bower
- Health Sciences Research Group, University of Manchester, Manchester, UK
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Wolleswinkel-van den Bosch JH, Stolk EA, Francois M, Gasparini R, Brosa M. The health care burden and societal impact of acute otitis media in seven European countries: results of an Internet survey. Vaccine 2011; 28 Suppl 6:G39-52. [PMID: 21075269 DOI: 10.1016/j.vaccine.2010.06.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper estimates medical resource use, direct costs, and productivity losses and costs (indirect costs) during episodes of acute otitis media (AOM) in young children. A 24-item Internet questionnaire was developed for parents in Belgium (Flanders), France, Germany, Italy, The Netherlands, Spain, and the United Kingdom (UK) to report health care resource use and productivity losses during the most recent episode of AOM in their child, younger than 5 years. The percentage who did not seek medical help for AOM was considerable in The Netherlands (28.3%) and the UK (19.7%). Antibiotic use was high, ranging from 60.8% (Germany) to 87.1% (Italy). Total costs per AOM episode ranged from €332.00 (The Netherlands) to €752.49 (UK). Losses in productivity accounted for 61% (France) to 83% (Germany) of the total costs. AOM poses a significant medical and economic burden to society.
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Validity of caregiver-reported hospital admission in a study on the quality of care received by terminally ill cancer patients. J Clin Epidemiol 2010; 63:103-8. [DOI: 10.1016/j.jclinepi.2009.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 07/01/2008] [Accepted: 02/13/2009] [Indexed: 11/21/2022]
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Agreement between self-reported and health insurance claims on utilization of health care: A population study. J Clin Epidemiol 2009; 62:1316-22. [DOI: 10.1016/j.jclinepi.2009.01.016] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2007] [Revised: 01/19/2009] [Accepted: 01/27/2009] [Indexed: 11/24/2022]
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Self-report versus care provider registration of healthcare utilization: Impact on cost and cost-utility. Int J Technol Assess Health Care 2009; 25:588-95. [DOI: 10.1017/s0266462309990432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility.Methods: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evaluating the effect of an INTERdisciplinary COMmunity-based management program (INTERCOM) for patients with chronic obstructive pulmonary disease (COPD). The program was offered by physiotherapists, dieticians and respiratory nurses. During the 2-year period, patients reported all resource use in a cost booklet. In addition, data on hospital admissions and outpatient visits, visits to the physiotherapist, dietician or respiratory nurse, diet nutrition, and outpatient medication were obtained from administrative records. The cost per quality-adjusted life-year (QALY) was calculated in two ways, using data from the cost booklet or registrations.Results: In total, 175 patients were included in the study. Agreement between self-report and registrations was almost perfect for hospitalizations (rho = 0.93) and physiotherapist visits (rho = 0.86), but above 0.55, moderate, for all other types of care. The total cost difference between the registrations and the cost booklet was 464 euros with the highest difference for hospitalizations 386 euro. Based on the cost booklet the cost difference between the treatment group and usual care was 2,444 euros (95 percent confidence interval [CI], −819 to 5,950), which resulted in a cost-utility of 29,100 euro/QALY. For the registrations, the results were 2,498 euros (95 percent CI, −88 to 6,084) and 29,390 euro/QALY, respectively.Conclusions: This study showed that the use of self-reported data or data from registrations effected within-group costs, but not between-group costs or the cost utility.
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Kephart G, Asada Y. Need-based resource allocation: different need indicators, different results? BMC Health Serv Res 2009; 9:122. [PMID: 19622159 PMCID: PMC2728712 DOI: 10.1186/1472-6963-9-122] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 07/21/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key policy objective in most publicly financed health care systems is to allocate resources according to need. Many jurisdictions implement this policy objective through need-based allocation models. To date, no gold standard exists for selecting need indicators. In the absence of a gold standard, sensitivity of the choice of need indicators is of concern. The primary objective of this study was to assess the consistency and plausibility of estimates of per capita relative need for health services across Canadian provinces based on different need indicators. METHODS Using the 2000/2001 Canadian Community Health Survey, we estimated relative per capita need for general practitioner, specialist, and hospital services by province using two approaches that incorporated a different set of need indicators: (1) demographics (age and sex), and (2) demographics, socioeconomic status, and health status. For both approaches, we first fitted regression models to estimate standard utilization of each of three types of health services by indicators of need. We defined the standard as average levels of utilization by needs indicators in the national sample. Subsequently, we estimated expected per capita utilization of each type of health services in each province. We compared these estimates of per capita relative need with premature mortality in each province to check their face validity. RESULTS Both approaches suggested that expected relative per capita need for three services vary across provinces. Different approaches, however, yielded different and inconsistent results. Moreover, provincial per capita relative need for the three health services did not always indicate the same direction of need suggested by premature mortality in each province. In particular, the two approaches suggested Newfoundland had less need than the Canadian average for all three services, but it had the highest premature mortality in Canada. CONCLUSION Substantial differences in need for health care may exist across Canadian provinces, but the direction and magnitude of differences depend on the need indicators used. Allocations from models using survey data lacked face validity for some provinces. These results call for the need to better understand the biases that may result from the use of survey data for resource allocation.
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Affiliation(s)
- George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada.
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Kayaniyil S, Leung YW, Suskin N, Stewart DE, Grace SL. Concordance of self- and program-reported rates of cardiac rehabilitation referral, enrollment and participation. Can J Cardiol 2009; 25:e96-9. [PMID: 19340365 DOI: 10.1016/s0828-282x(09)70063-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite potential bias, researchers often rely on patient self-reported data of health care use. However, the validity and accuracy of self-reported data on cardiac rehabilitation (CR) use are unknown. OBJECTIVE To assess the concordance between patient self-report and site-verified CR referral, enrollment and participation. METHODS A consecutive sample of 661 coronary artery disease inpatients (mean [+/- SD] age 61.27+/-1.31 years; 157 women [23.8%]) treated at three acute care sites was recruited (75% response rate) as part of a larger study comparing automatic with usual referral methods. CR referral, enrollment (attendance at intake assessment) and participation (percentage of program attended) were discerned in a mailed survey nine months following discharge (n=506; 84.3% retention). A total of 24 CR sites were contacted for verification. RESULTS A total of 276 participants (54.5%) self-reported CR referral, and CR sites verified receipt of 262 referrals (51.8%) (Cohen's kappa 0.899). A total of 232 participants (45.8%) self-reported CR enrollment, with site-verification for 208 participants (41.1%) (Cohen's kappa 0.846). Self-reported data indicated that participants attended a mean of 81.78+/-25.84% of prescribed CR sessions, with CR sites reporting that participants completed 80.75+/-31.27% of the program (r=0.662; P<0.001). Equivalency testing revealed that the self-reported and site-verified rates of program participation were equivalent (z<1.96). CONCLUSIONS The almost perfect agreement between the self-reported and site-verified use of CR services suggests that self-administered items are highly valid in this population.
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King M, Nazareth I, Levy G, Walker C, Morris R, Weich S, Bellón-Saameño JA, Moreno B, Svab I, Rotar D, Rifel J, Maaroos HI, Aluoja A, Kalda R, Neeleman J, Geerlings MI, Xavier M, de Almeida MC, Correa B, Torres-Gonzalez F. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry 2008; 192:362-7. [PMID: 18450661 DOI: 10.1192/bjp.bp.107.039966] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is evidence that the prevalence of common mental disorders varies across Europe. AIMS To compare prevalence of common mental disorders in general practice attendees in six European countries. METHOD Unselected attendees to general practices in the UK, Spain, Portugal, Slovenia, Estonia and The Netherlands were assessed for major depression, panic syndrome and other anxiety syndrome. Prevalence of DSM-IV major depression, other anxiety syndrome and panic syndrome was compared between the UK and other countries after taking account of differences in demographic factors and practice consultation rates. RESULTS Prevalence was estimated in 2,344 men and 4,865 women. The highest prevalence for all disorders occurred in the UK and Spain, and lowest in Slovenia and The Netherlands. Men aged 30-50 and women aged 18-30 had the highest prevalence of major depression; men aged 40-60 had the highest prevalence of anxiety, and men and women aged 40-50 had the highest prevalence of panic syndrome. Demographic factors accounted for the variance between the UK and Spain but otherwise had little impact on the significance of observed country differences. CONCLUSIONS These results add to the evidence for real differences between European countries in prevalence of psychological disorders and show that the burden of care on general practitioners varies markedly between countries.
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Affiliation(s)
- Michael King
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK.
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Murray KD, El-Mohandes AAE, El-Khorazaty MN, Kiely M. Low-income minority mothers' reports of infant health care utilisation compared with medical records. Paediatr Perinat Epidemiol 2007; 21:274-83. [PMID: 17439537 DOI: 10.1111/j.1365-3016.2007.00800.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study aimed to investigate mothers' reporting of the nature, location, frequency and content of health care visits for their infants, as compared with data abstracted from the infants' medical records. It was part of a community-based parenting intervention designed to improve preventive health care utilisation among minority mothers in Washington, DC. Mothers >or=18 years old with newborn infants and with poor or no prenatal care were enrolled in the study. A total of 160 mother-infant dyads completed the 12-month study. Mothers were interviewed when the infants were 4, 8 and 12 months old, and were asked to recall infant visits to all health care providers. Medical records from identified providers were used for verification. The number and type of immunisations given, types of providers visited, and reason for the visits were compared. Only about a quarter of mothers agreed with their infants' medical records on the number of specific immunisations received. The mothers reported fewer polio (1.8 vs. 2.1, P = 0.006), diphtheria and tetanus toxoids and pertussis (DTP) (1.8 vs. 2.2, P = 0.002), and Haemophilus influenzae type b (HiB) (1.3 vs. 2.1, P < 0.0001) immunisations than were recorded. Similarly, about a quarter of the mothers were unaware of any polio, DTP or hepatitis B immunisations given, as documented in the medical records, and 38% did not know that their infant was immunised for HiB. Nearly half of the mothers recalled more infant doctors' visits than were recorded in the medical records (4.1 vs. 3.6 visits, P = 0.017). The mothers generally disagreed with the providers about the reason for a particular visit and reported fewer sick-baby visits (1.5 vs. 3.3, P < 0.0001) than the providers recorded. Mothers' reports and medical records matched in only 19% of the cases. In 47%, mothers under-reported and in 34% over-reported the total number of visits. The strongest agreement between mothers' reports and medical records was in the case of emergency room visits (63%). In conclusion, in this population, mothers' reporting did not match that of providers with respect to specific information: the number of immunisations, the location where services were provided, and the classification of sick- vs. well-baby visits. Future studies that evaluate health care utilisation data should take these discrepancies into consideration in their selection of information source, and in their interpretation of the data.
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Affiliation(s)
- Kennan D Murray
- Statistics and Epidemiology Unit, RTI International, Rockville, MD, USA
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Asada Y, Kephart G. Equity in health services use and intensity of use in Canada. BMC Health Serv Res 2007; 7:41. [PMID: 17349059 PMCID: PMC1829158 DOI: 10.1186/1472-6963-7-41] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2006] [Accepted: 03/11/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago. Evidence has been conflicting as to what extent the Canadian health care system has met this goal of equitable access. The objective of this study was to examine whether and where socioeconomic inequities in health care utilization occur in Canada. METHODS We used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression. RESULTS We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals. CONCLUSION Our study unveiled possible socioeconomic inequities in the use of health care services in Canada.
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Affiliation(s)
- Yukiko Asada
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Centre for Clinical Research, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
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Jordan K, Jinks C, Croft P. Health care utilization: measurement using primary care records and patient recall both showed bias. J Clin Epidemiol 2006; 59:791-797. [PMID: 16828671 DOI: 10.1016/j.jclinepi.2005.12.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Revised: 11/04/2005] [Accepted: 12/05/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess reasons for discrepancies between primary care consultation measured from patient self-report and that based on medical records. METHODS Retrospective comparison of recalled consultation in previous 12 months among 2,414 subjects aged 50+ who reported knee pain in a population survey vs. primary care medical records. Record review included (1) all knee morbidity codes and (2) knee problems mentioned in consultation text. It was then extended to: (3) more than 12 months before survey, and (4) consultations for leg or widespread problems (e.g., generalized osteoarthritis). RESULTS In those who reported knee pain, recalled consultation prevalence for knee problems "in past year" was 33% compared with 15% based on medical records. Forty percent of those with a recalled consultation had a recorded knee problem in the same time period (kappa = 0.43). Expanding record search to include leg and widespread problems, and knee problems up to 40 months prior to survey, increased "verified" self-reported consulters to 80%. CONCLUSIONS Disparity in estimates of consultation prevalence arose from inaccuracy of: (1) recall in survey responders and (2) recording by general practitioners of specific problems and repeat consultations. Perceived importance of problem in a multiproblem contact and whether it leads to an outcome (e.g., prescription) may influence recording. Implications exist for service provision projections and research.
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Affiliation(s)
- Kelvin Jordan
- Primary Care Sciences Research Centre, Keele University, Keele ST5 5BG, United Kingdom.
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Bhandari A, Wagner T. Self-reported utilization of health care services: improving measurement and accuracy. Med Care Res Rev 2006; 63:217-35. [PMID: 16595412 DOI: 10.1177/1077558705285298] [Citation(s) in RCA: 484] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Self-report is often used to estimate health care utilization. However, the accuracy of such data is of paramount concern. The authors conducted a systematic review of 42 studies that evaluated the accuracy of self-report utilization data, where utilization was defined as a visit to a clinical provider or entity. They also present a broad conceptual model that identifies major issues to consider when collecting, analyzing, and reporting such data. The results show that self-report data are of variable accuracy. Factors that affect accuracy include (1) sample population and cognitive abilities, (2) recall time frame, (3) type of utilization, (4) utilization frequency, (5) questionnaire design, (6) mode of data collection, and (7) memory aids and probes.
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Abstract
Objectives:This study aimed to validate the accuracy of data retrieved in a prospective multicenter trial, the purpose of which was an economic evaluation of two techniques of surgery for colon cancer.Methods:Within the Swedish contribution of the COLOR trial (Colon Cancer Open or Laparoscopic Resection), an economic evaluation of open versus laparoscopic surgical techniques was conducted. Data were collected by case record forms (CRF), patient diaries, and telephone surveys every 2 weeks. The study period was 12 weeks, and the perspective was societal. Data from the first consecutive forty patients to complete the health economic study protocol were validated. Retrieved data were compared with data from medical records and data from local social security offices for agreement.Results:Statistically significant differences were found for duration of anesthesia, length of surgery, number of outpatient consultations by doctors and district nurses, complication rate, and the use of central venous lines. No significant differences were observed concerning length of hospital stay, disposable instruments cost, and time off work, all of which heavily influence total costs.Conclusions:The present method of data collection regarding resources used in this setting seems to produce accurate data for economic evaluation; however, relative to complication rates, the method did not retrieve accurate data.
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Dendukuri N, McCusker J, Bellavance F, Cardin S, Verdon J, Karp I, Belzile E. Comparing the Validity of Different Sources of Information on Emergency Department Visits. Med Care 2005; 43:266-75. [PMID: 15725983 DOI: 10.1097/00005650-200503000-00009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Emergency department (ED) use in Quebec may be measured from varied sources, eg, patient's self-reports, hospital medical charts, and provincial health insurance claims databases. Determining the relative validity of each source is complicated because none is a gold standard. OBJECTIVE We sought to compare the validity of different measures of ED use without arbitrarily assuming one is perfect. SUBJECTS Data were obtained from a nursing liaison intervention study for frail seniors visiting EDs at 4 university-affiliated hospitals in Montreal. MEASURES The number of ED visits during 2 consecutive follow-up periods of 1 and 4 months after baseline was obtained from patient interviews, from medical charts of participating hospitals, and from the provincial health insurance claims database. METHODS Latent class analysis was used to estimate the validity of each source. The impact of the following covariates on validity was evaluated: hospital visited, patient's demographic/clinical characteristics, risk of functional decline, nursing liaison intervention, duration of recall, previous ED use, and previous hospitalization. RESULTS The patient's self-report was found to be the least accurate (sensitivity: 70%, specificity: 88%). Claims databases had the greatest validity, especially after defining claims made on consecutive days as part of the same ED visit (sensitivity: 98%, specificity: 98%). The validity of the medical chart was intermediate. Lower sensitivity (or under-reporting) on the self-report appeared to be associated with higher age, low comorbidity and shorter length of recall. CONCLUSION The claims database is the most valid method of measuring ED use among seniors in Quebec compared with hospital medical charts and patient-reported use.
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Affiliation(s)
- Nandini Dendukuri
- Technology Assessment Unit, McGill University Health Center, Montreal, Canada.
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van den Brink M, van den Hout WB, Stiggelbout AM, van de Velde CJH, Kievit J. Cost measurement in economic evaluations of health care: whom to ask? Med Care 2004; 42:740-6. [PMID: 15258475 DOI: 10.1097/01.mlr.0000132351.78009.a1] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSES The purposes of this study were 1) to investigate the feasibility of using providers' administrative systems for the assessment of healthcare utilization in economic evaluations performed alongside multicenter studies, 2) to assess the convergent validity of patients' and providers' reports of care, and 3) to investigate whether differences between providers' and patients' reports are related to age, gender, health, recall period, and volumes of care. METHODS Data were obtained as part of a cost-utility analysis alongside a multicenter clinical trial in patients with rectal cancer. For a sample of 179 patients from 49 hospitals, data on hospitalizations, outpatient visits, medications, and care products during the first year after treatment were obtained from the patients by questionnaire or diary. For all patients, hospitals were contacted for information on hospitalizations and outpatient visits. For a subsample of 94 patients, 86 pharmacists and 10 suppliers of stoma care products were contacted for information on medications and care products. RESULTS Response by providers of care was high, ranging from 84% to 100%. With respect to hospital days and outpatient visits, we found no significant differences between patients' and providers' reports. For medications and care products, agreement was lower, with providers reporting up to 2 times more product types and costs than patients. Providers failed to report 20% to 25% of all products, whereas patients failed to report 50% to 60% of all products. CONCLUSIONS Patients' reports seem as valid as providers' reports for hospital days and outpatient visits. For medications and care products, we recommend the use of reports from providers of care, whenever feasible, because they much less underestimate volumes and costs than patients.
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Affiliation(s)
- Mandy van den Brink
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Van der Heyden JHA, Demarest S, Tafforeau J, Van Oyen H. Socio-economic differences in the utilisation of health services in Belgium. Health Policy 2003; 65:153-65. [PMID: 12849914 DOI: 10.1016/s0168-8510(02)00213-0] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate socio-economic differences in the use of health services in Belgium and to explore to what extent eventual socio-economic inequalities are explained by differences in demographic determinants and health needs. DESIGN Data was obtained from the 1997 Belgian national Health Interview Survey. In this survey information was collected on the health status, the life style and the medical consumption of a representative sample of the Belgian non-institutionalised population consisting of 8560 Belgian inhabitants aged 15 years and over. RESULTS Lower socio-economic groups make more often use of the general practitioner and nursing care at home and are more often admitted to hospital than persons with a high socio-economical status. There is, however, no socio-economic gradient when the health status is taken into account. On the opposite, persons with a higher socio-economic status report more often a visit to a specialist, a physiotherapist or a dentist. For the health services for which this was investigated no association was found between socio-economic status and the volume of the use of health services. CONCLUSIONS There are in Belgium still important socio-economic gradients in the use of some health services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services. Further research needs to focus on socio-economic differences in the reasons, the outcome and the quality of the provided care.
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Affiliation(s)
- J H A Van der Heyden
- Scientific Institute of Public Health, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
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Gilbert GH, Rose JS, Shelton BJ. A prospective study of the validity of data on self-reported dental visits. Community Dent Oral Epidemiol 2002; 30:352-62. [PMID: 12236826 DOI: 10.1034/j.1600-0528.2002.00062.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To measure the validity of self-reported dental visits from a diverse sample of adults. METHODS The Florida Dental Care Study was a longitudinal cohort study of a diverse sample of residents of north Florida, USA. In-person interviews and dental examinations were conducted at baseline, 24 and 48 months after baseline, with half-yearly telephone interviews in between. Dental record information was abstracted afterward. RESULTS Agreement between self-report and dental record at each half-yearly interview ranged from 84 to 91%. Validity did not differ between persons of key sociodemographic groups (sex, race, age group, rural/urban residence, poverty status, level of formal education, or problem-oriented/regular approach to dental care). In a single bivariate multiple logistic regression (two outcomes: (i) self-reported use; and (ii) use measured from the dental chart), odds ratio estimates over-lapped for each of the 20 predictors. CONCLUSIONS Validity of self-reported dental care use was good. There would have been few differences in conclusions made about predictors of dental care use had chart data been available earlier.
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Affiliation(s)
- Gregg H Gilbert
- Department of Diagnostic Sciences, School of Dentistry, University of Alabama, Birmingham, AL, USA.
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