Application and Use of Andersen's Behavioral Model as Theoretical Framework: A Systematic Literature Review from 2012-2021

Diabetes care cascade in Bangladesh: Identifying gaps and social determinants

AIMS

Precise and up-to-date data regarding the care gaps is essential to prioritize interventions and guide efficient resource allocation for management of diabetes in Bangladesh. The aim of the present study was to evaluate the diabetes care cascade and identify the social determinants influencing retention at each stage of care in Bangladesh.

METHODS

Data was extracted from Bangladesh Demographic and Health Survey (BDHS), 2022. Type 2 diabetes mellitus (T2DM) was defined as fasting blood glucose ≥7.0 mmol/L or a diagnosis by a healthcare provider. The care cascade comprised three stages: (i) diagnosis, (ii) receiving treatment, and (iii) glycemic control. Logistic regression and Andersen's Behavioral Model were used in the study.

RESULTS

Among 2,403 individuals with T2DM, 33.5 % were diagnosed, 24.6 % received treatment, and 9.6 % achieved glycemic control. Losses occurred at diagnosis (66.5 %), treatment (9 %), and control (19.6 %). Women, individuals with higher education, and those in the wealthiest quintile had higher odds of diagnosis. Receiving treatment was significantly associated with wealth and body mass index.

CONCLUSIONS

Significant gaps were observed at all stages of diabetes care cascade, particularly diagnosis. Strengthening screening, ensuring access to affordable treatment, and improving adherence are essential to enhance glycemic control and mitigating the diabetes burden.

Emergency department visits for children identified as at risk of mental and behavioral conditions in the United States: an analysis of the 2019 NHIS data

BACKGROUND

The prevalence of mental and behavioral health (MBH) conditions in children has been increasing in the past two decades. Emergency departments (EDs) are also experiencing a significant rise in MBH-related visits, leading to challenges in providing care. Gaining insight into the underlying characteristics of pediatric patients at higher risk of MBH conditions is crucial for understanding this population in the ED and addressing their complex care needs. This study aims to examine the characteristics of children reported to be at risk and not at risk of MBH conditions to identify the population characteristics associated with ED visits. The objective was to analyze data from the 2019 National Health Interview Survey (NHIS) to evaluate the odds of ED visits among children and to identify patterns among those at higher risk of MBH conditions.

METHODS

The study utilized data from the 2019 NHIS Sample Child Survey, focusing on children aged 6-17. Following established guidelines, children with a Strengths and Difficulties Questionnaire total score of 16 or higher were classified as having higher risk of MBH conditions. Binary logistic regression and ordinal logistic regression analyses were conducted in R. Three models were created; the first two examined factors among the general pediatric population associated with one ED visit or multiple ED visits within a year. The last model examined only children at higher risk of MBH conditions and the factors associated with ED visits in this sub-population.

RESULTS

The weighted sample size of the survey consisted of 49,330,998 children. Approximately 15.8% of children had been to the ED at least once in the past year and 6.6% of children were at risk of MBH conditions. The regression analyses revealed children reported at higher risk of MBH conditions were significantly more likely to visit the ED. Other factors associated with ED visits included preexisting health conditions such as asthma, suboptimal health status, and financial strain. Among children at higher risk of MBH conditions, having a consistent primary care setting (e.g., doctor's office or health center) was associated with significantly lower odds of visiting the ED.

CONCLUSIONS

The study provides insights into the characteristics of children with and without risk of MBH conditions, as well as their associated odds of ED visits. Understanding these factors can contribute to interventions and improvements within the ED for children presenting for MBH-related conditions. Further research is needed to improve care for this patient population in the ED.

Factors influencing intentional non-utilization of healthcare: a study using the Andersen model

Objective

This study aims to investigate the factors influencing residents' healthcare utilization behavior and provide a scientific basis for enhancing the overall efficiency of healthcare utilization.

Methods

A comprehensive analysis was conducted using data from the China General Social Survey (CGSS) project. Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM) were utilized to examine the influences and interrelationships of the three core factors of the Andersen Healthcare Utilization Model (Predisposing Factors, Enabling Resources, and Need), as well as the two extended factors (health behaviors and Medical-service Experience), on residents' decisions regarding the utilization of healthcare services.

Results

A total of 2,230 participants were enrolled in this study. Most were male (55.74%), were married (85.38%), and had junior- and senior-high school educations (45.29%). Mean age was 52.39 years, and 56.32% of participants reported an annual income of <30,000 RMB. EFA distilled influencing factors into four domains: Predisposing and Enabling, Need, Health Behaviors, and Medical-service Experience. The results of the revised SEM indicated that the influence coefficients of Predisposing and Enabling, Need, and Medical-service Experience on Decision to Utilize Health Services (DUHS) were 0.095, -0.104, and 0.093 respectively. Mediation effect test results demonstrated that the indirect effects of Predisposing and Enabling, Need, and Health Behaviors on DUHS were -0.098, 0.024, and -0.017, respectively, all of which were statistically significant. Finally, the fit indices of the modified model indicated an acceptable model fit.

Conclusion

This study showed that unmarried individuals with lower income and job instability exhibit reduced healthcare utilization due to economic barriers and lack of social support. Furthermore, medical service experience is another crucial factor affecting health service utilization. Notably, our findings suggest the need for targeted interventions, including enhanced insurance coverage, improving the quality of medical services and health education campaigns to mitigate disparities in access to health services.

Predictors of Service Awareness: Results from a Community Survey in an Urban Area

We examined information seeking strategies and predictors of service awareness from a 2019 survey of Detroit area adults. Participants were age 60+ (mean age = 72.10; SD = 8.08), and most were African American (89.0%) and female (86.9%). Most (74.80%) reported finding information most or all of the time, and 87.50% reported awareness of 12 to 15 services. Respondents with more frequent family/friend interaction (OR = 2.374, 95% CI = 1.054, 5.347), greater use of information seeking strategies (OR = 1.188, 95% CI = 15 1.073, 1.315), and higher health status (OR = 3.445, 95% CI =1.625, 7.306) were more likely to be aware of needed services. Women were aware of a greater number of services compared with men (OR = 2.682, 95% CI = 1.005, 7.160), while Hispanics/Latinos were aware of fewer services relative to African Americans (OR = 0.100, 95% CI = 0.012, 0.837. Greater information seeking strategies was associated with higher awareness (OR = 1.328, 95% CI = 1.150, 1.534). Results suggest the need for particular attention to linguistically and culturally appropriate outreach strategies for people who are Hispanic/Latino and those with a low level of social interaction.

Development of a core outcome set for clinical trials targeting interventions aiming to improve adherence to appropriate polypharmacy in older people-an international consensus study

BACKGROUND

Medication non-adherence is prevalent in older people taking polypharmacy. Several interventions have been employed to improve adherence in this population. However, inconsistencies in outcomes have impeded comparisons of findings. Accordingly, this work aimed to develop a core outcome set (COS) for use in trials aiming to improve adherence to appropriate polypharmacy in older people.

METHODS

A group of stakeholders, including academics, journal editors, healthcare professionals (HCPs) and public participants, evaluated 13 outcomes compiled from the literature in a Delphi study using a nine-point Likert scale ranging from 1 to 9, where higher scores (7-9) indicated critical importance and lower scores (1-3) unimportance. The resultant Delphi consensus list was discussed and voted on (yes: critical and no: unimportant) in two online nominal group technique (NGT) meetings. The NGT followed a five-stage approach: introduction, silent generation, round-robin, clarification and voting. An outcome was included if ≥80% of participants scored it critical and ≤ 15% scored it as unimportant.

RESULTS

Of the 13 outcomes originally presented to participants, consensus was achieved to include six outcomes in the COS after the Delphi study (Round 1, n = 57; Round 2, n = 53; Round 3, n = 50, where 'n' represents participant numbers) and the NGT meetings (n = 10) comprising medication adherence across multiple medications, treatment burden, health-related quality of life (HRQoL), healthcare utilisation (HCU), adverse events and side effects (AEs and SEs) and cost-effectiveness.

CONCLUSION

This COS should be used in intervention studies focusing on improving adherence to appropriate polypharmacy in older people. Future work should identify outcome measurement instruments to be used alongside the COS.

Factors influencing timely diagnosis of autism in China: an application of Andersen's behavioral model of health services use

BACKGROUND

Timely diagnosis of autism is pivotal for accessing crucial supports and services. However, achieving it remains a persistent challenge, particularly in countries like China where the healthcare system is characterized by its intricate network and often resulting in fragmented care delivery and disparities in access.

METHODS

A cross-sectional questionnaire survey was conducted among families with autistic children aged between 1 and 17 years in Chinese Mainland. Andersen's Behavioral Model guided the assessment of predisposing, enabling, and need factors.

RESULTS

The study revealed that 86.24% of Chinese children did not receive a formal diagnosis until after 24 months, with an average gap of 10.93 months between parents/caregivers' initial concerns and diagnostic confirmation. Predisposing factors of the child's current age emerged as a significant predictor for timely diagnosis. Enabling factors, including residence-hospital distance and experience of misdiagnosis were significant. Additionally, the severity level at diagnosis was identified as a predictor for timely diagnosis.

CONCLUSIONS

Our findings revealed that predisposing, enabling, and need factors contributed to the complex landscape of autism diagnosis in China. Strategies including implementing routine screening programs and adopting a multidisciplinary approach are crucial for timely identification and diagnosis, particularly for mild and moderate cases. Additionally, there is an urgent need for specialized autism training for healthcare professionals, the development of structured referral systems, and the expansion of telehealth solutions to ensure equitable access to diagnosis services across regions. By addressing these challenges, policymakers and healthcare providers can improve the accessibility and timeliness of autism diagnosis, ultimately enhancing the quality of life for affected individuals and their families.

Medicaid Expansion and Survival Outcomes Among Men With Prostate Cancer

INTRODUCTION

Prostate cancer stands as one of the most diagnosed malignancies among men worldwide. With the recent expansion of Medicaid under the Affordable Care Act (ACA), millions more Americans now have health insurance coverage, potentially influencing healthcare access and subsequent outcomes for various illnesses, including prostate cancer. Yet, the direct correlation between Medicaid expansion and cancer-specific survival among individuals with prostate cancer remains an area warranting comprehensive exploration.

OBJECTIVE

This study aims to determine the impact of the implementation of Medicaid expansion on survival outcomes among men with prostate cancer.

METHODS

We utilized data from the Surveillance, Epidemiology, and End Results (SEER) registry to determine the causal impact of the implementation of the ACA on outcomes among men with prostate cancer. The study covered the years 2003-2021, divided into pre-ACA (2003-2009) and post-ACA (2015-2021) periods, with a one-year washout (2014-2015) since Medicaid expansion was implemented in 2014 in Kentucky. Using a difference-in-differences (DID) approach, we compared survival among men with prostate cancers from Kentucky to Georgia. We adjusted for patient demographics, income, metropolitan status, disease stage, and treatment modalities.

RESULTS

We analyzed a cohort of 68,222 men with prostate cancer during the study period. Of these, 37,810 (55.4%) were diagnosed in the pre-ACA period, with 70.8% from Georgia and 29.2% from Kentucky. The remaining 30,412 (44.6%) were diagnosed in the post-ACA period, with 72.3% from Georgia and 27.7% from Kentucky. Medicaid expansion in Kentucky was associated with a 16.8% reduction in the hazard of overall death, indicating improved overall survival among eligible individuals. This trend was consistent across different racial and ethnic groups. Specifically, non-Hispanic White men experienced a 16.2% reduction (DID=-16.2%; 95% CI: -31.5% to -0.8%), non-Hispanic Black men had a 17.9% reduction (DID=-17.9%; 95% CI: -34.8% to -0.9%), and Hispanic men saw a 15.9% reduction (DID=-15.9%; 95% CI: -31.3% to -0.5%) in hazard of death among low-income individuals.

CONCLUSION

Medicaid expansion was associated with a substantive improvement in overall survival among men with prostate cancer in Kentucky compared to non-expansion Georgia.

Service Utilization and Consumer-Reported Unmet Needs in Medicaid Home- and Community-Based Services for Older Adults

Home- and community-based services (HCBS) are increasingly favored over nursing home care by older consumers and by policymakers. Consumer-reported unmet service needs in HCBS are important service quality and person-centeredness indicators. Yet, we know little about consumer-reported unmet needs among HCBS users. Therefore, we evaluated consumer-reported unmet needs (i.e. that the services they receive currently were not meeting their needs and goals) for 9,693 Medicaid HCBS beneficiaries (age ≥65 years) in the National Core Indicators-Aging and Disability survey (2016-2019). Personal care (59.7%) and homemaker (24.4%) services were the most utilized HCBS. Prevalence of unmet needs was highest in transportation (12.2%) and homemaker (11.7%) services. Consumers with poorer self-rated health, dementia, or mental illness; ndividuals living alone; and people of color were more likely to report unmet needs in HCBS such as personal care, caregiver support, adult day, or transportation. Proxy survey respondents were more likely to report unmet needs in caregiver support and personal care services and less likely to report unmet needs in transportation services. Consumer-reported unmet needs might indicate barriers to accessing HCBS. Our findings indicate differences in predictors of unmet needs by service categories, which should inform future targeted policymaking by state agencies and service providers to improve HCBS.

Predictors of cost-related medication nonadherence in Canada: a repeated cross-sectional analysis of the Canadian Community Health Survey

BACKGROUND

In Canada, many patients face substantial out-of-pocket costs for prescription medication, which may affect their ability to take their medications as prescribed. We sought to conduct a comprehensive analysis of the burden and predictors of cost-related nonadherence in Canada.

METHODS

Using pooled data from the 2015, 2016, 2018, 2019, and 2020 iterations of the Canadian Community Health Survey, we calculated weighted population estimates of the burden of cost-related nonadherence in the preceding 12 months and used logistic regression models to measure the association of 15 demographic, health, and health system predictors of cost-related nonadherence overall and stratified by sex.

RESULTS

We included 223 085 respondents. We found that 4.9% of respondents aged 12 years or older reported cost-related nonadherence. Those who self-identified as female, belonging to a racial or ethnic minority group, or bisexual, pansexual, or questioning were more likely to report cost-related nonadherence. Younger age, higher disease burden, poorer health, non-employer prescription drug coverage, and not living in the province of Quebec were associated with cost-related nonadherence.

INTERPRETATION

Our nationally representative findings reveal inequities that disproportionally affect marginalized people at the intersections of sex, race, age, and disability, and vary by province. This foundational understanding of the state of cost-related nonadherence may be used to inform potential expansion of public drug coverage eligibility, premiums, and cost-sharing policies that address financial barriers to medication adherence.

Comparative impact of the affordable care act on breast cancer outcomes among women in two US states

Introduction

Since the implementation of the Patient Protection and Affordable Care Act (ACA) and Medicaid expansion, states that adopted the policy have seen reduced uninsured rates. However, it is unclear whether increased healthcare access, particularly for minority and socioeconomically disadvantaged groups, has translated into measurable improvements in health outcomes.

Objective

Our study aims to evaluate the impact of the ACA and Medicaid expansion on breast cancer outcomes in Louisiana, which has implemented the policy, compared to Georgia, which has not, as of 2024.

Methodology

We conducted a retrospective study using SEER registry data from January 2011 to December 2021, including women aged 18-64 diagnosed with breast cancer. The impact of the ACA and Medicaid expansion on cancer-specific survival (CSS), overall survival (OS), and stage at presentation was evaluated. The cohort was divided into pre-ACA (2011-2015) and post-ACA (2017-2021) periods, with a one-year washout (2016). A difference-in-difference (DID) approach compared outcomes between Louisiana and Georgia.

Results

The study analyzed 62,381 women with breast cancer, with 32,220 cases in the pre-ACA period (51.7%) and 30,161 in the post-ACA period (48.3%). In Georgia, 43,279 women were included (52.3% pre-ACA vs. 47.7% post-ACA), while Louisiana had 19,102 women (50.1% pre-ACA vs. 49.9% post-ACA). Medicaid expansion in Louisiana was associated with a 0.26 percentage point reduction in overall deaths (95% CI: -10.9 to 10.4) and a 5.97 percentage point reduction in cancer-specific mortality (95% CI: -26.1 to 14.2). There was also no significant difference in disease stage at presentation compared to Georgia.

Conclusion

This study found no significant differences in overall mortality, cancer-specific mortality, or disease stage at presentation among women with breast cancer in Louisiana, which implemented Medicaid expansion in 2016, compared to Georgia, which has not expanded Medicaid.

Disparities in the Use of Annual Heart Health Screenings Among Latino, Black, and Asian Immigrants: Evidence from the 2011 to 2018 National Health Interview Survey

BACKGROUND

Immigrants are disproportionately affected by cardiovascular disease burden. Heart health screenings, including blood pressure, fasting blood glucose (FBG), and blood cholesterol screenings, can help identify cardiovascular disease risk. Evidence on heart health screenings among diverse immigrant groups is still limited. This study examined the disparities in heart health screenings among the immigrant population compared with US-born White adults.

METHODS AND RESULTS

A cross-sectional design was used to analyze data from the 2011 to 2018 National Health Interview Survey. Generalized linear models with Poisson distribution were applied to compare the prevalence of annual blood pressure, fasting blood glucose, and blood cholesterol screenings among Latino, Black, and Asian immigrants and US-born White adults. The analysis included 145 149 adults (83.60% US-born White adults, 9.55% Latino immigrants, 1.89% Black immigrants, and 4.96% Asian immigrants), with a mean age of 50 years and 53.62% women. Latino (adjusted odds ratio [aOR], 0.92 [95% CI, 0.91-0.93]) and Asian (aOR, 0.93 [95% CI, 0.92-0.94]) immigrants were less likely to have blood pressure screening than US-born White adults. Latino (aOR, 1.22 [95% CI, 1.19-1.25]), Black (aOR, 1.15 [95% CI, 1.09-1.21]), and Asian (aOR, 1.12 [95% CI, 1.08-1.15]) immigrants were more likely to have fasting blood glucose screening, and Latino (aOR, 1.11 [95% CI, 1.09-1.13]), Black or (aOR, 1.12 [95% CI, 1.09-1.16]), and Asian (aOR, 1.05 [95% CI, 1.04-1.07]) immigrants were more likely to have blood cholesterol screening than US-born White adults.

CONCLUSIONS

Latino and Asian immigrants have lower odds of annual blood pressure screenings than US-born White adults. More studies exploring facilitators and barriers to the accessibility and use of heart health screenings are needed.

Experiences of access and use of primary health care by users with systemic arterial hypertension

OBJECTIVE

To identify and analyze users' perceptions of access and use of health services and actions to monitor Systemic Arterial Hypertension (SAH) in Primary Health Care (PHC).

METHODS

This is a qualitative, descriptive and exploratory study based on 38 semi-structured interviews conducted with users selected from Basic Health Units (BHUs) in a large municipality in the state of Rio de Janeiro. Thematic content analysis was used to identify the empirical categories.

RESULTS

Users faced difficulties in scheduling appointments, accessing laboratory test results and medicines at the BHU. Home visits by Community Health Workers (CHWs) intermediated demands for appointments and tests. There were no health education activities and follow-up by the nursing team was residual. The doctor was the main reference, although links were weakened by turnover.

CONCLUSION

The study identified the need to expand access to basic medicines and test results at the BHU, the role of nurses in promotional, preventive and clinical actions, the scope of CHWs' work in health education and interprofessional work.

Help-Seeking Preferences and Influencing Factors Among Chinese Nurses Exposed to COVID-19: A Person-Centered Approach

PURPOSE

This study aimed to explore help-seeking preference categories and crucial influencing factors among community nurses exposed to COVID-19 in China using a new person-centered approach.

DESIGN

A cross-sectional design including an online self-reported questionnaire survey was used.

METHODS

A total of 667 nurses who participated in COVID-19 prevention and control work were recruited. Latent class analysis and logistic regression were used to analyze the data using Mplus and SPSS.

FINDINGS

Two latent classes of help-seeking preferences were identified: high help-seeking preferences (33.58%) and low help-seeking preferences (66.42%). Most sampled nurses had relatively low help-seeking preferences when facing psychological threats during COVID-19. Logistic regression showed that career duration, perceived social support, online help-seeking intention, and social media exposure negatively affected low help-seeking preferences.

CONCLUSIONS

Career duration, perceived social support, online help-seeking intention, and social media exposure could be key factors influencing help-seeking preferences among Chinese nurses exposed to public emergencies. It is necessary to implement relevant intervention measures, such as focusing on nurses whose career durations are shorter, improving nurses' perceived social support, strengthening positive media publicity, and developing comprehensive online mental health services that promote nurses' help-seeking preferences and behaviors to reduce mental illness during public health emergencies.

CLINICAL EVIDENCE

Help-seeking preferences are relatively low among Chinese nurses during public emergencies. Based on the major influencing factors of help-seeking preferences, including social support and social media exposure, more interventions must be developed for prompting psychological help-seeking intentions among Chinese nurses.

Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCD Plus clinics: multilevel analysis

BACKGROUND

Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year.

METHODS

This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis.

RESULTS

24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 - 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06-2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively.

CONCLUSIONS

NCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics.

The doctor will not see you now: investigating the social determinants of specialist care using the Canadian Longitudinal Study on Aging (CLSA)

Background

The Canada Health Act mandates universal access to medical services for all Canadians. Despite this, there are significant disparities in access based on socioeconomic status, race and ethnicity, immigrant status, and indigeneity. However, there is limited evidence on the use of specialist services among older adults in Canada. The primary objective of this study is to identify the associations of social determinants of health with access to medical specialist services for Canadians aged 45 years and older. The second objective is to identify the reasons for not being able to access the needed specialist care.

Methods

A cross-sectional analysis of the Canadian Longitudinal Study on Aging survey was conducted. Based on the Andersen's model of health services use, a multivariable logistic regression model was used to evaluate the associations between 'not being able to access the needed specialist service(s) in the last 12 months' and individual-level sociodemographic determinants.

Results

Approximately 97% of those who required specialist care in the last year were able to visit a specialist. Of the participants who were not able to access the needed specialist services, about half (50.90%) were still waiting for a visit. The following factors were associated with greater difficulty in accessing specialist care: being younger (45-54 years), living in a rural area, having some post-secondary education, having a household income below $50,000 a year, not having a family physician, and having fair or poor perceived general health. Residents of British Columbia and Nova Scotia had a higher likelihood of reporting difficulty compared to those residing in Ontario.

Conclusion

While a majority of respondents were able to access specialist services when needed, those who had difficulty in accessing care were more likely to come from socially marginalized groups. Targeted policy interventions and improved health system coordination can reduce these barriers to care.

Evaluation of an Embedded Health Psychologist Intervention for Obstetric Patients With Adverse Childhood Experiences

BACKGROUND

Screening for adverse childhood experiences (ACEs) and resilience in pregnancy is a promising practice for mitigating ACEs-related health complications. Yet, the best follow-up for pregnant patients with high ACEs and/or low resilience has not been established.

OBJECTIVE

This study evaluates referrals to and participation in an embedded health psychologist (EHP) intervention for pregnant patients with ACEs and/or low resilience.

MATERIALS AND METHODS

Patients in 3 Kaiser Permanente Northern California medical centers with ACEs who had also received resilience screening during standard prenatal care and who were participating in an EHP intervention were included (N = 910). The authors used multivariable logistic regression to examine whether ACEs (0, 1-2, 3+) and resilience (high vs low) were associated with referrals to and participation in EHP intervention. They also evaluated the impact of EHP intervention through clinician (N = 53) and patient (N = 51) surveys.

RESULTS

Patients with 3+ vs 0 ACEs were more likely to receive an EHP referral (adjusted odds ratio [aOR] = 2.89, 95% confidence interval [CI]: 1.93-4.33) and were more likely to participate in EHP intervention (aOR = 2.85, 95% CI: 1.87-4.36). Those with low vs high resilience were also more likely to receive an EHP referral (aOR = 1.86, 95% CI: 1.32-2.62) and participate in EHP (aOR = 1.71, 95% CI: 1.19-2.44). When ACEs and resilience were combined, those with high ACEs and low resilience had the greatest odds of referrals and participation. Patients and clinicians reported positive experiences with EHP intervention.

CONCLUSION

Patients with higher ACEs and lower resilience scores were more likely to be referred to and participate in EHP intervention, suggesting that at-risk patients can be successfully linked with a health psychologist when accessible within obstetric care.

Direct healthcare expenditure on Alzheimer's disease from healthcare providers' perspective in Malaysia: a micro-costing approach

Alzheimer's disease (AD) is an important geriatric disease that creates challenges in health policy planning. There is no previous attempt to quantify the actual direct healthcare cost of AD among older adults in Malaysia. This retrospective observational study with bottom-up micro-costing approach aimed to evaluate the direct healthcare expenditure on AD along with its potential predictors from healthcare providers' perspective, conducted across six tertiary hospitals in Malaysia. AD patients aged 65 and above who received AD treatment between 1 January 2016 and 31 December 2021 were included. Direct healthcare cost (DHC) of AD was estimated by extracting one-year follow-up information from patient medical records. As a result, 333 AD patients were included in the study. The mean DHC of AD was estimated RM2641.30 (USD 572.45) per patient per year (PPPY) from the healthcare payer's perspective. Laboratory investigations accounted for 37.2% of total DHC, followed by clinic care (31.5%) and prescription medicine (24.9%). As disease severity increases, annual DHC increases from RM2459.04 (mild), RM 2642.27 (moderate), to RM3087.61 (severe) PPPY. Patients aged 81 and above recorded significantly higher annual DHC (p = 0.003). Such real-world estimates are important in assisting the process of formulating healthcare policies in geriatric care.

The impact of COVID-19 on health service utilization in sub-Saharan Africa-a scoping review

BACKGROUND

Despite comparatively low rates of COVID-19 admissions and recorded deaths in sub-Saharan Africa (SSA), the pandemic still had significant impact on health service utilization (HSU). The aim of this scoping review is to synthesize the available evidence of HSU in SSA during the pandemic, focusing on types of studies, changes in HSU compared with the pre-pandemic period, and changes among specific patient groups.

METHODS

The scoping review was guided by the methodological framework for conducting scoping reviews developed by Arksey and O'Malley. We identified relevant studies through a search of PubMed (MEDLINE), Embase, Scopus, and Web of Science. We then provided a general descriptive overview of the extracted data focusing on the types of studies, patient groups, and change in HSU.

RESULTS

We identified 262 studies reporting on HSU in 39 SSA countries. Studies were mainly quantitative (192; 73.3%), involving multiple centers (163; 62.2%), conducted in hospitals (205; 78.2%), and in urban settings (121; 46.2%). The median number of participants was 836.5 (IQR: 101.5-5897) involving 62.5% females. Most studies (92; 35.1%) focused on communicable diseases and mainly among outpatients (90; 34.2%). Maternal and child health studies formed the largest patient group (58; 22.1%) followed by people living with HIV (32; 12.2%). Change in HSU was reported in 249 (95.0%) studies with 221 (84.4%) studies reporting a decrease in HSU. The median decrease in HSU was 35.6% (IQR: 19.0-55.8) and median increase was 16.2% (IQR: 9.1-31.9). The patient group with the largest percentage decrease was cardiovascular diseases (68.0%; IQR: 16.7-71.1) and the lowest percentage decrease was in patients with infections (27.0%; IQR: 16.6-45.6).

CONCLUSIONS

A large body of literature is available on the effects of the pandemic on HSU in SSA. Most studies report decreases in HSU during the pandemic. However, patterns differ widely across disease categories, patient groups, and during different time periods of the pandemic.

Men of Mexican ethnicity, alcohol use, and help-seeking: "I can quit on my own."

INTRODUCTION

Hispanics report higher rates of problematic alcohol use compared to non-Hispanic Whites while also reporting lower rates of alcohol treatment utilization compared to non-Hispanics. The study employs Anderson's Behavioral Model of Healthcare Utilization Model to guide the exploration of alcohol use, help-seeking and healthcare utilization.

METHODS

The present qualitative study explored help-seeking and alcohol treatment utilization for Hispanic men of Mexican ethnicity. A total of 27 participants (Mage = 35.7, SD = 10.82) completed a semi-structured interview that explored the treatment experiences and underlying psychological mechanisms that shaped their help-seeking.

RESULTS

Through a thematic content analysis, the following themes emerged: 1) perceiving need with subthemes of familismo, role as protector and provider, and positive face; 2) predisposing beliefs on help-seeking; and 3) treatment experiences and elements of patient satisfaction with subthemes of monetized treatment, respect, and perceiving professional stigma.

CONCLUSIONS

The findings in this article may assist in improving strategies for increasing alcohol treatment utilization among men of Mexican ethnicity. By exploring beliefs, values, and experiences health researchers can develop culturally informed intervention strategies.

Factors associated with non-urgent presentations in the paediatric emergency department using Andersen's behavioural model: A cross-sectional descriptive study

OBJECTIVES

To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model.

METHODS

We conducted a descriptive cross-sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain).

RESULTS

The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first-time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031).

CONCLUSIONS

The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs.

IMPLICATIONS FOR PRACTICE

Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well-being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high-quality PC services. Providing support to parents during the transition to parenthood would also be beneficial.

REPORTING METHOD

This paper adheres to the STROBE initiative guidelines.

CONTRIBUTION FROM PATIENTS OR MEMBERS OF THE PUBLIC

Participants, who voluntarily agreed to take part, contributed to the study by completing a paper-based questionnaire containing all the study variables as prepared by the research team.

Research Guided by the Theory of Care-Seeking Behavior: A Scoping Review

BACKGROUND

A particular Theory of Care-Seeking Behavior was developed to explain care-seeking behavior with psychosocial concepts, external conditions, and clinical and demographic factors. Having a careful review of studies based on this theory could guide future research on care-seeking behaviors.

OBJECTIVES

With a scoping review: describe characteristics of studies guided by a Theory of Care-Seeking Behavior, summarize support for the relationships of proposed, explanatory variables with care-seeking behaviors, and examine support for propositions in the theory.

METHOD

Searching 5 electronic databases, we sought studies that were: full-text, peer-reviewed, in English, data-based, guided by the theory, and published from January 1, 1992, to January 1, 2022.

RESULTS

Across 18 identified articles, the behaviors studied included: symptomatic screening (n = 8), asymptomatic screening (n = 7), and care-seeking behaviors for either screening or symptoms (n = 3). A total of 3328 adults participated in the studies. In 16 studies, all participants were female. In 60% to 83% of studies, researchers had reported findings that supported the relationships of explanatory concepts with care-seeking behavior. Among the 7 studies that tested the 2 propositions of theory, all 7 tests failed to support the proposition that clinical and demographic factors influence care-seeking behavior indirectly through psychosocial variables. Six tests supported the proposition that psychosocial variables influence behavior conditionally, on external conditions.

CONCLUSIONS

Relationships of these explanatory variables with care-seeking behaviors were supported, as was 1 of 2 propositions. The Theory of Care-Seeking Behavior can be applied to new clinical situations to continue to build knowledge of the theory and understanding of care-seeking behaviors.

Choice Preference of Middle-Aged and Elderly People on Integrated Medical Services and Elderly Care Model: A Cross-Sectional Study

Facing the increasingly severe aging situation, China has started to implement the "integrated medical services and elderly care (IMSEC)" policy, which covers a variety of IMSEC models. However, there is currently little research on middle-aged and elderly people's choice preference for these IMSEC models and their associated factors. Through the face-to-face questionnaire method, the choice preference of middle-aged and elderly people aged 45 years and over in Zhejiang Province, China, to the IMSEC model is explored. Through the multinomial logistic regression model, the influencing factors of choice preference are analyzed. A total of 1034 people are included in 2022. Their choice preference for the 4 major types of IMSEC models are Home IMSEC model (48.07%), Community IMSEC model (23.79%), Institutional IMSEC model (21.76%), and Internet Plus IMSEC model (6.38%). "C1. Home elderly care and contracted with a family doctor" is the most chosen subtype, accounting for 34.53%. The rural elderly are more likely to choose "Home IMSEC model" (OR(95%CI) = 2.977(1.343-6.601)). Elderly people with relatively large life care needs are more likely to choose "Institutional IMSEC model" (OR(95%CI) = 1.114(1.042-1.190)). Moreover, age, education, and self-reported health status are also influencing factors of choice preference. The government should focus on promoting the development of the "Home IMSEC model" and increase the promotion of "Internet Plus IMSEC model." In addition, the life care service capacity and spiritual comfort capacity of IMSEC institutions, as well as the medical service capacity of the community, need to be enhanced.