Body awareness and medical care utilization among older adults in an HMO

This study investigated the association between the disposition of body awareness and medical care utilization among older adult members of a health maintenance organization (HMO). Results indicated that higher levels of body awareness are associated significantly with longitudinal increases in the volume of patient-initiated illness visits to the HMO, and with a greater likelihood of patient-initiated contact with the hospital emergency room, controlling for prior utilization, self-reported health status, and other factors. In contrast, body awareness was not associated significantly with longitudinal changes in physician-initiated follow-up visits, internal referrals, external referrals, or hospital inpatient days. Other findings indicated that higher levels of patient-initiated utilization were associated with greater physician-initiated utilization, controlling for prior utilization. These results illustrate how patient-initiated utilization may influence subsequent physician-initiated utilization.     

Health care and medication costs and use among older adults with heart failure

BACKGROUND: Heart failure disproportionately affects older adults for whom multiple medications are prescribed to prevent exacerbations and hospitalization. To target interventions effectively, it is important to understand the association of medication acquisition with health care utilization and costs. METHODS: We used electronic medical records from an urban public health care system to identify patients aged >/=50 years who had a diagnosis of heart failure. We assessed the association between inappropriate or appropriate medication supplies and hospitalization and costs using multivariable analyses that adjusted for demographic characteristics, prior health care use, health status, and insurance status. RESULTS: Total health care costs for treating 1554 patients with heart failure from 1996 to 2000 were 36.6 million dollars (in 2000 dollars). Less than a third of patients received appropriate medication supplies (between 90% and 110% of the supplies needed) annually. Compared with patients with appropriate supplies, the odds of hospitalization were greater among those with undersupplies (odds ratio [OR] = 3.1; 95% confidence interval [CI]: 2.3 to 4.2; P <0.0001) or oversupplies (OR = 2.0; 95% CI: 1.7 to 2.4; P <0.0001). Total costs were 25% higher for patients with undersupplies (95% CI: 8% to 46%; P = 0.004) and 18% higher for those with oversupplies (95% CI: 7% to 30%; P = 0.0009) than for those with appropriate supplies. CONCLUSION: Among adults with heart failure, inappropriate medication supplies were associated with increased hospitalization and higher costs. Monitoring medication supplies from electronic medical records may be a useful component of programs aiming to improve care while managing costs.     

Emergency department utilization patterns among older adults

BACKGROUND: We identified 4-year (2 years before and 2 years after the index [baseline] interview) ED use patterns in older adults and the factors associated with them. METHODS: A secondary analysis of baseline interview data from the nationally representative Survey on Assets and Health Dynamics Among the Oldest Old linked to Medicare claims data. Participants were 4310 self-respondents 70 years old or older. Current Procedural Terminology (CPT) codes 99281 and 99282 identified low-intensity use, and CPT codes 99283-99285 identified high-intensity use. Exploratory factor analysis and multivariable multinomial logistic regression were used. RESULTS: The majority (56.6%) of participants had no ED visits during the 4-year period. Just 5.7% had only low-intensity ED use patterns, whereas 28.9% used the ED only for high-intensity visits, and 8.7% had a mixture of low-intensity and high-intensity use. Participants with lower immediate word recall scores and those who did not live in major metropolitan areas were more likely to be low-intensity-only ED users. Older individuals, those who did not live in rural counties, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to be high-intensity-only ED users. Participants who were older, did not live in major cities, had lower education levels, had greater morbidity and functional status burdens, and lower immediate word recall scores were more likely to have mixed ED use patterns. CONCLUSIONS: Nearly half of these older adults used the ED at least once over a 4-year period, with a mean annual ED use percentage of 18.4. Few, however, used the ED only for visits that may have been avoidable. This finding suggests that triaging Medicare patients would not decrease ED overcrowding, although continued surveillance is necessary to detect potential changes in ED use patterns among older adults.     

Gender and ethnic/racial disparities in health care utilization among older adults

OBJECTIVE: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. METHODS: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. RESULTS: African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. DISCUSSION: Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.     

Health services utilization between older and younger homeless adults

PURPOSE: Our purpose in the current study was to examine the relationship between health services utilization delivered by means of the Homeless Outreach Medical Services (HOMES) program and health services utilization delivered by means of the Parkland emergency room and inpatient units among a sample of older and younger homeless adults being served by the Parkland Health and Hospital System. DESIGN AND METHODS: The HOMES program uses two 40-ft-long mobile medical units and a fixed-site outpatient clinic to provide primary health care on a walk-in, no-charge basis to individuals who are homeless. We used a quasi-experimental design, and we randomly selected health services utilization data from 293 male (50.4%) and 288 female (49.6%) homeless patients from among the 14,876 homeless patients aged 20-64 years who used HOMES and the Parkland Health and Hospital System between June 1, 1992, and June 30, 1999. The dependent variables were measurements of inpatient and outpatient utilization of psychiatric, substance abuse, and musculoskeletal services by homeless patients. Inpatient and outpatient utilization patterns by age were assessed. Data were analyzed using a split-plot repeated measures multivariate analysis of variance (MANOVA), one-way analysis of variance (ANOVA), and simple linear regression. RESULTS: Older homeless individuals utilized the HOMES more than inpatient services for substance abuse and musculoskeletal conditions, but they utilized inpatient services the most for psychiatric-related conditions. IMPLICATIONS: This level of inpatient utilization is perhaps a result of greater severity or progression of mental illness among older homeless adults. The level of outpatient utilization is probably because the HOMES program mitigates many of the barriers that prevent homeless individuals from obtaining primary medical care.     

Health care resource utilization in adults with congenital heart disease

The number of adults with congenital heart disease (CHD) is increasing. However, rates of health care resource utilization in this population are unknown. The objectives of this study were to describe the use of general health care resources in adults with CHD and to examine the impact of CHD severity on resource utilization. The study consisted of adults alive in 1996 who had > or = 1 diagnosis of a CHD lesion conforming to the International Classification of Disease, Ninth Revision, in the physician's claims database of the province of Quebec from 1983 to 2000. From 1996 to 2000, rates of health care utilization were measured. The impact of the severity of CHD on the use of health care resources was determined using multivariate models to adjust for age, gender, Charlson co-morbidity score, and duration of follow-up. The study population consisted of 22,096 adults with CHD (42% men). From 1996 to 2000, 87% received outpatient care from specialists, 68% visited emergency rooms, 51% were hospitalized, and 16% were admitted to critical care units. Patients with severe CHD had higher adjusted rates of outpatient cardiologist care (rate ratio [RR] 2.24, 95% confidence interval [CI] 2.06 to 2.45), emergency department utilization (RR 1.09, 95% CI 1.03 to 1.17), hospitalization (RR 1.30, 95% CI 1.19 to 1.43), and days in critical care (RR 2.12, 95% CI 1.80 to 2.50) than patients with other congenital cardiac lesions. Hospitalization rates were higher than in the general Quebec adult population (RR 2.08, 95% CI 2.00 to 2.17). In conclusion, adults with CHD have high rates of health care resource utilization, particularly those with severe lesions. Appropriate resource allocation is required to serve this growing population.     

Multidimensional social support is associated with healthcare utilization among older Mexican adults

In this study, we aimed to estimate the association between social support and healthcare utilization among older Mexican adults. We conducted a prospective study with 4027 older adults aged 65–74 in rural areas in seven Mexican states. Data were collected at baseline (2007) and 14 months later (2009). Healthcare utilization was defined as number of visits to a physician for preventive or curative purposes in the last 6 months. Multidimensional social support was operationalized into two components: structural (living arrangements, marital status and network size) and functional (perceived availability of support; and perceived support across emotional, instrumental, economic and information domains). Mixed-effects regression models were used to estimate the probability of healthcare use and to examine the association between social support and the number of visits to a physician. Results showed that perceived availability of social support was associated with the probability of visits to a physician (OR 1.44; p < .01). Meanwhile, the following domains of functional component of social support were associated with the probability of visits to a physician: instrumental (OR 1.55; p < .01), economic (OR 1.19; p = .03) and informational (OR 1.39; p < .01); and also with the number of visits to a physician: instrumental (e ^β  = 1.27; p < .01), economic (e ^β  = 1.14; p = .01) and informational (e ^β  = 1.12; p < .10). Our findings suggest that a significant association exists between social support, measured from a multidimensional viewpoint, and healthcare utilization, in which greater social support was related to a greater extent of use of health services.     

Health conditions and service utilization of adults with elder care responsibilities

This study examines health conditions and health care services utilization rates of 628 caregivers and 6,599 noncaregivers age 50 or older who were members of Kaiser Foundation Health Plan in Northern California. Controlling for age, gender, and race, caregivers were more likely than noncaregivers to report backaches, insomnia, arthritis, rectal problems, and hearing problems; they were also more likely to report having two or more current health conditions of any kind. However, caregivers and noncaregivers did not differ significantly with regard to the number of outpatient medical visits or with regard to the number of outpatient psychiatry visits.     

Effects of health literacy to self‐efficacy and preventive care utilization among older adults

Aim: This study examined the relationships between health literacy, self‐efficacy and preventive care utilization among older adults in Taiwan. Methods: The data were from a longitudinal survey, “Taiwan Longitudinal Study in Aging” in 2003 and 2007. A total of 3479 participants who completed both two waves were included for analysis. Health literacy first was constructed through education, cognitive function and disease knowledge through structural equation modeling (SEM); then, the associations of health literacy to later self‐efficacy and preventive care were examined. Results: The model fit of SEM was good, indicating that the construct of health literacy was appropriate. Healthy literacy showed a moderate positive effect on self‐efficacy and a small positive effect on preventive care utilization. Conclusions: Health literacy increases self‐efficacy and utilization of preventive care. Promoting people's health knowledge and health literacy is suggested. Geriatr Gerontol Int 2013; 13: 70–76 .     

The impact of managed care on health care utilization among adults with asthma.

STUDY OBJECTIVES: To compare kinds and amounts of health care used by adults with asthma in managed care and fee-for-service settings. DESIGN: Cross-sectional structured telephone survey of Northern California adults with asthma from random samples of pulmonologists, allergist-immunologists, family practitioners, and from a random sample of the non-institutionalized population. MEASUREMENTS: Validated measures of kind of health insurance plans, kinds and amounts of services used for asthma and other reasons, demographic characteristics, severity of asthma, comorbidity, and overall health and functional status. RESULTS: Eighty one percent of the 416 adults with asthma studied were in some form of managed care (75% in HMOs and 6% in PPOs). Those in managed care (MC) and fee-for-service (FFS) did not differ substantively in the proportion with a regular source or principal provider of asthma care, with a peak flow meter or action plan, having received instructions in the use of an inhaler, reporting current use of inhaled beta-agonists, home nebulized beta-agonists, or inhaled steroids, or reporting ER visits or flu shots in the year prior to interview. Persons with asthma in MC reported significantly fewer total physician visits (after adjustment, 4.3 MC, 7.1 FFS, difference = 2.8, 95% CI -5.4, -0.1), principally because those in MC had many fewer visits to allergist-immunologists (after adjustment 4.9 MC, 21.4 FFS, difference = -16.5, 95% CI -27.8, -5.3). The two groups did not differ significantly in the proportion with asthma-related or nonasthma hospital admissions. CONCLUSIONS: Persons with asthma in fee-for-service settings reported a greater number of certain kinds of ambulatory visits, particularly visits to allergist-immunologists, for their asthma than those in managed care, but did not differ in the use of the hospital for their asthma and in nonasthma care.     

Effect of physical activity on functional status among older middle-age adults with arthritis

OBJECTIVE: To determine the effect of leisure time and work-related physical activity on changes in physical functioning among 3,554 nationally representative survey respondents, ages 53-63 years in 1994, with arthritis and joint symptoms, interviewed in the Health and Retirement Study (HRS). METHODS: In 1992-1994, light and vigorous exercise items were empirically categorized into recommended, insufficient, and inactive leisure time physical activity levels using data from the HRS. Leisure and work-related physical activity levels in 1994 were used to predict 1996 functional decline or improvement, controlling for baseline functional difficulties, health status, sociodemographic characteristics, and behavioral risk factors. RESULTS: Whereas 29.7% of respondents reported functional declines in 1996, 38.6% of those with baseline difficulties in 1994 reported improvement. Compared with inactive respondents, recommended and insufficient leisure time physical activity were equally protective against functional decline (odds ratio [OR] 0.59 and 0.62, respectively; P < 0.0001). Higher levels of physical activity were also modestly associated with functional improvement among respondents with baseline functional difficulties (OR 1.47, P = 0.05 and OR 1.45, P = 0.01, respectively). Work-related physical activity was not a significant predictor of decline or improvement. CONCLUSION: Given the high prevalence of arthritis, even modest increases in rates of lifestyle physical activity among older adults could make a substantial contribution to disability-free life expectancy.