Journal articles on the topic 'Healthcare utilisation'
To see the other types of publications on this topic, follow the link: Healthcare utilisation.
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Healthcare utilisation.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Zhang, Yi-Na, Yun Chen, Ying Wang, Fan Li, Michelle Pender, Na Wang, Fei Yan, Xiao-Hua Ying, Sheng-Lan Tang, and Chao-Wei Fu. "Reduction in healthcare services during the COVID-19 pandemic in China." BMJ Global Health 5, no. 11 (November 2020): e003421. http://dx.doi.org/10.1136/bmjgh-2020-003421.
Full textAbstract:
IntroductionThe COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19’s impact on national and regional healthcare service utilisation and expenditure in China.MethodsUsing a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak.ResultsHealthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%–89.3% of its pre-outbreak levels.ConclusionThe COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.
2
Beaney, Thomas, Jonathan Clarke, Thomas Woodcock, Rachel McCarthy, Kavitha Saravanakumar, Mauricio Barahona, Mitch Blair, and Dougal S. Hargreaves. "Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London." BMJ Open 11, no. 12 (December 2021): e050847. http://dx.doi.org/10.1136/bmjopen-2021-050847.
Full textAbstract:
ObjectivesWith a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation methods to distinguish patterns of healthcare utilisation in children and young people (CYP) and to explore predictors of segment membership.DesignA retrospective cohort study.SettingRoutinely collected primary and secondary healthcare data in Northwest London from the Discover database.Participants378 309 CYP aged 0–15 years registered to a general practice in Northwest London with 1 full year of follow-up.Primary and secondary outcome measuresAssignment of each participant to a segment defined by seven healthcare variables representing primary and secondary care attendances, and description of utilisation patterns by segment. Predictors of segment membership described by age, sex, ethnicity, deprivation and LTCs.ResultsParticipants were grouped into six segments based on healthcare utilisation. Three segments predominantly used primary care, two moderate utilisation segments differed in use of emergency or elective care, and a high utilisation segment, representing 16 632 (4.4%) children accounted for the highest mean presentations across all service types. The two smallest segments, representing 13.3% of the population, accounted for 62.5% of total costs. Younger age, residence in areas of higher deprivation and the presence of one or more LTCs were associated with membership of higher utilisation segments, but 75.0% of those in the highest utilisation segment had no LTC.ConclusionsThis article identifies six segments of healthcare utilisation in CYP and predictors of segment membership. Demographics and LTCs may not explain utilisation patterns as strongly as in adults, which may limit the use of routine data in predicting utilisation and suggest children have less well-defined trajectories of service use than adults.
3
Stewart, Catherine Louise, and Jennifer Anne Hall. "Factors that affect the utilisation of maternal healthcare in the Mchinji District of Malawi." PLOS ONE 17, no. 12 (December 30, 2022): e0279613. http://dx.doi.org/10.1371/journal.pone.0279613.
Full textAbstract:
Background It is widely accepted that maternal healthcare is vital for improving maternal and neonatal mortality rates. Furthermore, the continuum of care–the integrated delivery of antenatal, delivery and postnatal care–has been shown to be particularly important. Sub-Saharan Africa has the highest neonatal and maternal mortality rates in the world; significant improvements in the provision and utilisation of the continuum are urgently needed, therefore the barriers preventing access need to be better understood. This study aimed to identify key factors associated with the utilisation of maternal healthcare, in the Mchinji District of Malawi. Methods 4,244 pregnant women from the Mchinji District of Malawi were interviewed between March and December 2013. The overall utilisation of maternal healthcare was calculated by combining the use of antenatal, delivery and postnatal care into one variable—continuum of care. Univariate and multivariate logistic regressions were performed to determine the factors associated with utilisation of maternal healthcare. Results Utilisation of maternal healthcare in the Mchinji District was inadequate; only 24% of women received the recommended package. Being further from a healthcare facility (OR = 0.2, 95%CI = 0.04–0.96), having at least one live child (OR = 0.87, 95%CI = 0.84–0.99), previous experience of miscarriage (OR = 0.64, 95%CI = 0.50–0.82) or abuse (OR = 0.81, 95%CI = 0.69–0.95) reduced utilisation, whereas being in the richest 20% (OR = 1.33 95%CI = 1.08–1.65), having a planned pregnancy (OR = 1.3, 95%CI = 1.11–1.51) or more control over decisions (OR = 1.09, 95%CI = 0.80–1.49) increased utilisation. Conclusion Seven groups of women were identified as having an increased risk of low utilisation of maternal healthcare; women living >5km from a healthcare facility, within the poorest socio-economic group, experiencing an unplanned pregnancy, with at least one live child, experience of a previous miscarriage, no control over their healthcare decisions or experience of abuse. Policy makers should pay extra attention to these high-risk groups when designing and delivering strategies to improve maternal healthcare utilisation.
4
Harvey, Sarah, Joanna Bromley, Miles Edwards, Megan Hooper, Hannah McAndrew, and Joanne Timms. "Audit of the impact of the integrated psychological medicine service (IPMS) on service utilisation." BJPsych Open 7, S1 (June 2021): S80—S81. http://dx.doi.org/10.1192/bjo.2021.252.
Full textAbstract:
AimsAn audit to assess the impact of an Integrated Psychological Medicine Service (IPMS) on healthcare utilization pre & post intervention. We hypothesized that an IPMS approach would reduce healthcare utilization.BackgroundThe IPMS focusses on integrating biopsychosocial assessments into physical healthcare pathways. It has developed in stages as opportunities presented in different specialities leading to a heterogeneous non-standardised service. The key aim is involvement of mental health practitioners, psychologists & psychiatrists in complex patients with comorbidity or functional presentations in combination with the specialty MDT. This audit is the first attempt to gather data across all involved specialities and complete a randomised deep dive into cases.MethodReferrals into IMPS from July 2019 to June 2020 pulled 129 referrals, of which a 10% randomised sample of 13 patients was selected to analyse. 5 patients had one year of data either side of the duration of the IPMS intervention (excluding 8 patients with incomplete data sets).We analysed; the duration & nature of the IPMS intervention, the number, duration & speciality of inpatient admissions & short stays, outpatient attendances, non-attendances & patient cancellations. Psychosocial information was also gathered. One non-randomised patient was analysed as a comparative case illustration.ResultRandomised patients; patient 78's utilisation remained static, patient 71 post-referral engaged with health psychology & reduced healthcare utilisation. Patient 7 increased healthcare utilisation post-referral secondary to health complications. Patient 54 did not attend & increased healthcare utilisation post-referral. Patient 106 had increased healthcare utilisation post-referral from a new health condition. The randomised sample identified limitations of using healthcare utilisation as an outcome measure when contrasted to the non-randomised case (which significantly reduced healthcare utilisation post-referral).ConclusionCorrelation only can be inferred from the data due to sample size, limitations & confounding factors e.g. psycho-social life events, acquired illness. Alternative outcome measurements documented (e.g PHQ9/GAD7) were not reliably recorded across pathways.The results evidenced that single cases can demonstrate highly desirable effects of a biopsychosocial approach but they can also skew data sets if results are pooled due to the small sample size & heterogeneous interventions. With some patients an increase in healthcare utilisation was appropriate for an improved clinical outcome. This audit identified that utilising healthcare utilisation as an outcome measure is a crude tool with significant limitations & the need to agree tailored outcome measures based on the type of intervention to assess the impact of IPMS.
5
Rosen, Tony, Yuhua Bao, Yiye Zhang, Sunday Clark, Katherine Wen, Alyssa Elman, Philip Jeng, et al. "Identifying patterns of health care utilisation among physical elder abuse victims using Medicare data and legally adjudicated cases: protocol for case–control study using data linkage and machine learning." BMJ Open 11, no. 2 (February 2021): e044768. http://dx.doi.org/10.1136/bmjopen-2020-044768.
Full textAbstract:
IntroductionPhysical elder abuse is common and has serious health consequences but is under-recognised and under-reported. As assessment by healthcare providers may represent the only contact outside family for many older adults, clinicians have a unique opportunity to identify suspected abuse and initiate intervention. Preliminary research suggests elder abuse victims may have different patterns of healthcare utilisation than other older adults, with increased rates of emergency department use, hospitalisation and nursing home placement. Little is known, however, about the patterns of this increased utilisation and associated costs. To help fill this gap, we describe here the protocol for a study exploring patterns of healthcare utilisation and associated costs for known physical elder abuse victims compared with non-victims.Methods and analysisWe hypothesise that various aspects of healthcare utilisation are differentially affected by physical elder abuse victimisation, increasing ED/hospital utilisation and reducing outpatient/primary care utilisation. We will obtain Medicare claims data for a series of well-characterised, legally adjudicated cases of physical elder abuse to examine victims’ healthcare utilisation before and after the date of abuse detection. We will also compare these physical elder abuse victims to a matched comparison group of non-victimised older adults using Medicare claims. We will use machine learning approaches to extend our ability to identify patterns suggestive of potential physical elder abuse exposure. Describing unique patterns and associated costs of healthcare utilisation among elder abuse victims may improve the ability of healthcare providers to identify and, ultimately, intervene and prevent victimisation.Ethics and disseminationThis project has been reviewed and approved by the Weill Cornell Medicine Institutional Review Board, protocol #1807019417, with initial approval on 1 August 2018. We aim to disseminate our results in peer-reviewed journals at national and international conferences and among interested patient groups and the public.
6
Sonik, Rajan A., Alisha Coleman-Jensen, and Susan L. Parish. "Household food insufficiency, health status and emergency healthcare utilisation among children with and without special healthcare needs." Public Health Nutrition 23, no. 17 (June 9, 2020): 3204–10. http://dx.doi.org/10.1017/s1368980020000361.
Full textAbstract:
AbstractObjective:To compare exposure to household food insufficiency and the relationship between household food insufficiency and both health status and emergency healthcare utilisation among children with and without special healthcare needs (SHCN).Design:Analysing pooled data from the 2016–2017 iterations of the National Survey of Children’s Health, we conducted multivariate logistic regressions on household food insufficiency, health status and emergency healthcare utilisation. We assessed interactions between household food insufficiency and children’s SHCN status in our models of health status and utilisation.Setting:United States.Participants:Parents of a nationally representative sample of non-institutionalised children (aged 0–17 years).Results:Children with SHCN were more likely to experience household food insufficiency (70 v. 56 %), non-excellent health status (67 v. 28 %) and emergency healthcare utilisation (32 v. 18 %) than other children. Household food insufficiency was associated with 37 % (children with SHCN) and 19 % (children without SHCN) reductions in the likelihood of having excellent health. Household food insufficiency was associated with a roughly equal (16–19 %) increase in the likelihood of emergency department utilisation across groups.Conclusions:Compared with other children, children with SHCN have an elevated risk of exposure to household food insufficiency and experiencing greater reductions in health status when exposed.
7
Viktorsson, Lisa, Eva Törnvall, Magnus Falk, Ingrid Wåhlin, and Pia Yngman‐Uhlin. "Young adults' healthcare utilisation and healthcare needs: Perceptions and experiences of healthcare providers." Health Expectations 25, no. 1 (October 8, 2021): 245–53. http://dx.doi.org/10.1111/hex.13370.
Full text
8
Schnyder, N., C. Michel, R. Panczak, S. Ochsenbein, B. G. Schimmelmann, and F. Schultze-Lutter. "The interplay of etiological knowledge and mental illness stigma on healthcare utilisation in the community: A structural equation model." European Psychiatry 51 (June 2018): 48–56. http://dx.doi.org/10.1016/j.eurpsy.2017.12.027.
Full textAbstract:
AbstractBackground:The stigma of mental illness, especially personal attitudes towards psychiatric patients and mental health help-seeking, is an important barrier in healthcare utilisation. These attitudes are not independent of each other and are also influenced by other factors, such as mental health literacy, especially the public’s causal explanations for mental problems. We aimed to disentangle the interrelations between the different aspects of stigma and causal explanations with respect to their association with healthcare utilisation.Methods:Stigma and causal explanations were assessed cross-sectional using established German questionnaires with two unlabelled vignettes (schizophrenia and depression) in a random-selection representative community sample (N = 1375, aged 16–40 years). They were interviewed through a prior telephone survey for current mental disorder (n = 192) and healthcare utilisation (n = 377). Structural equation modelling was conducted with healthcare utilisation as outcome and stigma and causal explanations as latent variables. The final model was additionally analysed based on the vignettes.Results:We identified two pathways. One positive associated with healthcare utilisation, with high psychosocial stress and low constitution/personality related causal explanations, via positive perception of help-seeking and more help-seeking intentions. One negative associated with healthcare utilisation, with high biogenetic and constitution/personality, and low psychosocial stress related explanations, via negative perception of psychiatric patients and a strong wish for social distance. Sensitivity analysis generally supported both pathways with some differences in the role of biogenetic causal explanation.Conclusion:Our results indicate that campaigns promoting early healthcare utilisation should focus on different strategies to promote facilitation and reduce barriers to mental healthcare.
9
Meulman, Iris, Ellen Uiters, Johan Polder, and Niek Stadhouders. "Why does healthcare utilisation differ between socioeconomic groups in OECD countries with universal healthcare coverage? A protocol for a systematic review." BMJ Open 11, no. 11 (November 2021): e054806. http://dx.doi.org/10.1136/bmjopen-2021-054806.
Full textAbstract:
IntroductionEven in advanced economies with universal healthcare coverage (UHC), a social gradient in healthcare utilisation has been reported. Many individual, community and healthcare system factors have been considered that may be associated with the variation in healthcare utilisation between socioeconomic groups. Nevertheless, relatively little is known about the complex interaction and relative contribution of these factors to socioeconomic differences in healthcare utilisation. In order to improve understanding of why utilisation patterns differ by socioeconomic status (SES), the proposed systematic review will explore the main mechanisms that have been examined in quantitative research.Methods and analysisThe systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines and will be conducted in Embase, PubMed, Scopus, Web of Science, Econlit and PsycInfo. Articles examining factors associated with the differences in primary and specialised healthcare utilisation between socioeconomic groups in Organisation for Economic Co-operation and Development (OECD) countries with UHC will be included. Further restrictions concern specifications of outcome measures, factors of interest, study design, population, language and type of publication. Data will be numerically summarised, narratively synthesised and thematically discussed. The factors will be categorised according to existing frameworks for barriers to healthcare access.Ethics and disseminationNo primary data will be collected. No ethics approval is required. We intend to publish a scientific article in an international peer-reviewed journal.
10
Kazanga, Isabel, Alister C. Munthali, Joanne McVeigh, Hasheem Mannan, and Malcolm MacLachlan. "Predictors of Utilisation of Skilled Maternal Healthcare in Lilongwe District, Malawi." International Journal of Health Policy and Management 8, no. 12 (August 13, 2019): 700–710. http://dx.doi.org/10.15171/ijhpm.2019.67.
Full textAbstract:
Background: Despite numerous efforts to improve maternal and child health in Malawi, maternal and newborn mortality rates remain very high, with the country having one of the highest maternal mortality ratios globally. The aim of this study was to identify which individual factors best predict utilisation of skilled maternal healthcare in a sample of women residing in Lilongwe district of Malawi. Identifying which of these factors play a significant role in determining utilisation of skilled maternal healthcare is required to inform policies and programming in the interest of achieving increased utilisation of skilled maternal healthcare in Malawi. Methods: This study used secondary data from the Woman’s Questionnaire of the 2010 Malawi Demographic and Health Survey (MDHS). Data was analysed from 1126 women aged between 15 and 49 living in Lilongwe. Multivariate logistic regression was conducted to determine significant predictors of maternal healthcare utilisation. Results: Women’s residence (P=.006), education (P=.004), and wealth (P=.018) were significant predictors of utilisation of maternal healthcare provided by a skilled attendant. Urban women were less likely (odds ratio [OR] = 0.47, P=.006, 95% CI = 0.28–0.81) to utilise a continuum of maternal healthcare from a skilled health attendant compared to rural women. Similarly, women with less education (OR = 0.32, P=.001, 95% CI = 0.16–0.64), and poor women (OR = 0.50, P=.04, 95% CI = 0.26–0.97) were less likely to use a continuum of maternal healthcare from a skilled health attendant. Conclusion: Policies and programmes should aim to increase utilisation of skilled maternal healthcare for women with less education and low-income status. Specifically, emphasis should be placed on promoting education and economic empowerment initiatives, and creating awareness about use of maternal healthcare services among girls, women and their respective communities.
11
HernandezNavarro Espigares, Jose Luis, Elisa Hernández Torres, and Teresa García Muñoz. "Population Ageing, Dependency and Healthcare Services Utilisation." Studies of Applied Economics 26, no. 2 (June 13, 2021): 1–30. http://dx.doi.org/10.25115/eea.v26i2.5555.
Full textAbstract:
The increase in the percentage of the elderly (the population 65 years or older) in developed countries is a cause for concern about the levels of health care services expenditures and the widening of long-term care services in these countries. The current debate includes the issue of establishing a system of protection for dependence as a new modality of social protection. The objective of this paper is to analyse the evolution of the degree of dependence in the Spanish population over 65 years during the period between 1997 and 2003, and to estimate the impact of dependence on health status and health care utilisation for the same period. An increasing trend of dependence prevalence as well as of the consumption of health care services has been found. A statistical association between the degree of dependence and the variables of health status, drug consumption and in-patient services has been observed. But this association is not significant in the case of medical consultations. The low degree of association between dependence and out-patient health care services strengthens the hypothesis that the elderly population presents specific necessities, oriented to assistance of dependence needs rather than ambulatory health care services.
12
Dagne, Asrat Hailu, and Mequannent Melaku Ayalew. "Factors affecting research utilisation of nurses and midwives working in North Gondar and West Gojjam Zone public hospitals, Ethiopia: a cross-sectional study." BMJ Open 10, no. 11 (November 2020): e039586. http://dx.doi.org/10.1136/bmjopen-2020-039586.
Full textAbstract:
BackgroundResearch utilisation in clinical decision-making is crucial to enhance quality healthcare, professional development and cost-effective health service. Nurses and midwives have a vital role in research utilisation. However, many factors influence research utilisation of nurses and midwives.ObjectivesTo determine research utilisation and identify factors that affect research utilisation among nurses and midwives.MethodsAn institutional-based, cross-sectional study was conducted from 23 May to 30 June 2019. A total of 631 nurses and midwives participated in the study. Categorical variables were coded with dummy variables and multiple linear regression model was carried out. The level of significance was set at p value less than or equal to 0.05 with 95% CI.ResultsParticipants’ total mean score in the research utilisation scale was 2.27 (SD±0.77) and their mean age was 28.41 (SD±4.71) years. The study revealed that 70.4% (444) of participants had poor research utilisation. Self-efficacy in research utilisation skills (B=0.86, 95% CI 0.75 to 0.97), support for research utilisation (B=0.4, 95% CI 0.25 to 0.55), attitude (B=0.23, 95% CI 0.07 to 0.38), barriers to research utilisation (B=−0.63, 95% CI −0.72 to −0.54), nursing/midwifery work index (B=0.07, 95% CI 0.04 to 0.11) and hospital’s level of healthcare (B=4.5, 95% CI 2.13 to 6.9) were statistically significantly associated factors of research utilisation.ConclusionsThis study revealed poor research utilisation among nurses and midwives. Barriers to research utilisation, supporting factors for research utilisation, attitude, self-efficacy in research utilisation skills, hospital’s level of healthcare and nursing/midwifery work index were found to be statistically significant predictors of research utilisation. The most common barriers to research utilisation were insufficient time and inability to understand statistical terms used in research articles.
13
Ahmed, Sayem, Abdur Razzaque Sarker, Marufa Sultana, Felix Roth, Rashidul Alam Mahumud, Md Kamruzzaman, Md Zahid Hasan, et al. "Do employer-sponsored health insurance schemes affect the utilisation of medically trained providers and out-of-pocket payments among ready-made garment workers? A case–control study in Bangladesh." BMJ Open 10, no. 3 (March 2020): e030298. http://dx.doi.org/10.1136/bmjopen-2019-030298.
Full textAbstract:
ObjectiveWe estimated the effect of an employer-sponsored health insurance (ESHI) scheme on healthcare utilisation of medically trained providers and reduction of out-of-pocket (OOP) expenditure among ready-made garment (RMG) workers.DesignWe used a case–control study design with cross-sectional preintervention and postintervention surveys.SettingsThe study was conducted among workers of seven purposively selected RMG factories in Shafipur, Gazipur in Bangladesh.ParticipantsIn total, 1924 RMG workers (480 from the insured and 482 from the uninsured, in each period) were surveyed from insured and uninsured RMG factories, respectively, in the preintervention (October 2013) and postintervention (April 2015) period.InterventionsWe tested the effect of a pilot ESHI scheme which was implemented for 1 year.Outcome measuresThe outcome measures were utilisation of medically trained providers and reduction of OOP expenditure among RMG workers. We estimated difference-in-difference (DiD) and applied two-part regression model to measure the association between healthcare utilisation, OOP payments and ESHI scheme membership while controlling for the socioeconomic characteristics of workers.ResultsThe ESHI scheme increased healthcare utilisation of medically trained providers by 26.1% (DiD=26.1; p<0.01) among insured workers compared with uninsured workers. While accounting for covariates, the effect on utilisation significantly reduced to 18.4% (p<0.05). The DiD estimate showed that OOP expenditure among insured workers decreased by −3700 Bangladeshi taka and -1100 Bangladeshi taka compared with uninsured workers when using healthcare services from medically trained providers or all provider respectively, although not significant. The multiple two-part models also reported similar results.ConclusionThe ESHI scheme significantly increased utilisation of medically trained providers among RMG workers. However, it has no significant effect on OOP expenditure. It can be recommended that an educational intervention be provided to RMG workers to improve their healthcare-seeking behaviours and increase their utilisation of ESHI-designated healthcare providers while keeping OOP payments low.
14
Hamiduzzaman, Mohammad, Anita De-Bellis, Wendy Abigail, and Amber Fletcher. "Critical social framework on the determinants of primary healthcare access and utilisation." Family Medicine and Community Health 9, Suppl 1 (November 2021): e001031. http://dx.doi.org/10.1136/fmch-2021-001031.
Full textAbstract:
This paper aims to contextualise ‘healthcare access and utilisation’ within its wider social circumstances, including structural factors that shape primary healthcare for marginalised groups. Mainstream theories often neglect complexities among the broader social, institutional and cultural milieus that shape primary healthcare utilisation in reality. A blended critical social framework is presented to highlight the recognition and emancipatory intents surrounding person, family, healthcare practice and society. Using the theoretical contributions of Habermas and Honneth, the framework focuses on power relationships, misrecognition/recognition strategies, as well as disempowerment/empowerment dynamics. To enable causal and structural analysis, we draw on the depth ontology of critical realism. The framework is then applied to the case of rural elderly women’s primary healthcare use in Bangladesh. Drawing on the literature, this article illustrates how a blended critical social perspective reveals the overlapping and complex determinants that affect primary healthcare utilisation, before concluding with the importance of situating healthcare access in sociocultural structures.
15
Liu, Lingrui, Hannah H. Leslie, Martias Joshua, and Margaret E. Kruk. "Exploring the association between sick child healthcare utilisation and health facility quality in Malawi: a cross-sectional study." BMJ Open 9, no. 7 (July 2019): e029631. http://dx.doi.org/10.1136/bmjopen-2019-029631.
Full textAbstract:
ObjectiveIncreasing the availability of basic healthcare services in low-and middle-income countries is not sufficient to meet the Sustainable Development Goal target for child survival in high-mortality settings, where healthcare utilisation is often inconsistent and quality of care can be poor. We assessed whether poor quality of sick child healthcare in Malawi is associated with low utilisation of sick child healthcare.DesignWe measured two elements of quality of sick child healthcare: facility structural readiness and process of care using data from the 2013 Malawi Service Provision Assessment. Overall quality was defined as the average of these metrics. We extracted demographic data from the 2013–2014 Malawi Multiple Indicator Cluster Survey and linked households to nearby facilities using geocodes. We used logistic regression to examine the association of facility quality with utilisation of formal health services for children under 5 years of age suffering diarrhoea, fever or cough/acute respiratory illness, controlling for demographic and socioeconomic characteristics. We conducted sensitivity analyses (SAs), modifying the travel distance and population—facility matching criteria.Setting and population568 facilities were linked with 9701 children with recent illness symptoms in Malawi, of whom 69% had been brought to a health facility.ResultsOverall, facilities showed gaps in structural quality (62% readiness) and major deficiencies in process quality (33%), for an overall quality score of 48%. Better facility quality was associated with higher odds of utilisation of sick child healthcare services (adjusted ORs (AOR): 1.66, 95% CI: 1.04 to 2.63), as was structural quality alone (AOR: 1.33, 95% CI: 0.95 to 1.87). SAs supported the main finding.ConclusionAlthough Malawi’s health facilities for curative child care are widely available, quality and utilisation of sick child healthcare services are in short supply. Improving facility quality may provide a way to encourage higher utilisation of healthcare, thereby decreasing preventable childhood morbidity and mortality.
16
Paine, Sarah-Jane, Ricci Harris, James Stanley, and Donna Cormack. "Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand." Archives of Disease in Childhood 103, no. 9 (March 23, 2018): 873–79. http://dx.doi.org/10.1136/archdischild-2017-313866.
Full textAbstract:
ObjectivesChildren’s exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. We aimed to investigate (1) the prevalence of vicarious racism by child ethnicity; (2) the association between caregiver experiences of racism and child healthcare utilisation; and (3) the contribution of caregiver socioeconomic position and psychological distress to this association.DesignCross-sectional analysis of two instances of the New Zealand Health Survey (2006/2007: n=4535 child–primary caregiver dyads; 2011/2012: n=4420 dyads).Main outcome measuresChildren’s unmet need for healthcare, reporting no usual medical centre and caregiver-reported dissatisfaction with their child’s medical centre.ResultsThe prevalence of reporting ‘any’ experience of racism was higher among caregivers of indigenous Māori and Asian children (30.0% for both groups in 2006/2007) compared with European/Other children (14.4% in 2006/2007). Vicarious racism was independently associated with unmet need for child’s healthcare (OR=2.30, 95% CI 1.65 to 3.20) and dissatisfaction with their child’s medical centre (OR=2.00, 95% CI 1.26 to 3.16). Importantly, there was a dose–response relationship between the number of reported experiences of racism and child healthcare utilisation (eg, unmet need: 1 report of racism, OR=1.89, 95% CI 1.34 to 2.67; 2+ reports of racism, OR=3.06, 95% CI 1.27 to 7.37). Adjustment for caregiver psychological distress attenuated the association between caregiver experiences of racism and child healthcare utilisation.ConclusionsVicarious racism is a serious health problem in New Zealand disproportionately affecting Māori and Asian children and significantly impacting children’s healthcare utilisation. Tackling racism may be an important means of improving inequities in child healthcare utilisation.
17
Soley-Bori, Marina, Mark Ashworth, Alessandra Bisquera, Hiten Dodhia, Rebecca Lynch, Yanzhong Wang, and Julia Fox-Rushby. "Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature." British Journal of General Practice 71, no. 702 (November 23, 2020): e39-e46. http://dx.doi.org/10.3399/bjgp20x713897.
Full textAbstract:
BackgroundManaging multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK.AimTo assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components.Design and settingA systematic review.MethodThis systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible.ResultsSeventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity.ConclusionIn the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.
18
Delling, Francesca N., Eric Vittinghoff, Thomas A. Dewland, Mark J. Pletcher, Jeffrey E. Olgin, Gregory Nah, Kirstin Aschbacher, et al. "Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA." BMJ Open 9, no. 5 (May 2019): e027432. http://dx.doi.org/10.1136/bmjopen-2018-027432.
Full textAbstract:
ObjectiveTo assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK).DesignWe used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK.SettingPopulation-based, inpatient.ParticipantsHCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states.Main outcome measuresWe used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states.ResultsIn CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state).ConclusionsRecreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.
19
Klein, Jens, Annette Strauß, Sarah Koens, Ingmar Schäfer, and Olaf von dem Knesebeck. "Intended healthcare utilisation in cases of severe COVID-19 and inflammatory gastrointestinal disease: results of a population survey with vignettes." BMJ Open 12, no. 3 (March 2022): e057644. http://dx.doi.org/10.1136/bmjopen-2021-057644.
Full textAbstract:
ObjectivesTo examine variations in intended healthcare utilisation in severe cases of COVID-19 and inflammatory gastrointestinal disease (IGD).DesignRepresentative cross-sectional telephone survey.Setting and participants1207 randomly drawn adults of the city of Hamburg, Germany, between November 2020 and January 2021.Outcome measuresDifferent vignettes with severe symptoms were presented varying in sex, age (child, middle-aged person, older person), daytime (Tuesday morning or Tuesday evening) and disease (COVID-19 or IGD), while the degree of urgency was equivalent for all cases. The respondents were asked for the intended healthcare utilisation resulting in three different alternatives: general practitioner (GP)/paediatrician, medical on-call service (‘116117’) and emergency care (accident and emergency department, emergency practice, rescue service). In multivariate analyses, associations of characteristics of the vignettes and participants (sex, age, education, migration background) with intended healthcare utilisation were tested. In a further step, analyses were conducted separately for IGD and COVID-19.ResultsRegarding the vignettes’ characteristics, intended utilisation of GP/paediatrician is associated with female sex, higher age, daytime (morning) and COVID-19 symptoms, the medical on-call service with male sex, daytime (evening) and COVID-19 symptoms and the emergency medicine with younger age, daytime (evening) and IGD. Women chose more often the GP/paediatrician, men preferred emergency medicine. Only in case of IGD, higher educated persons more often chose the medical on-call service while people with a migration background decided less often for medical on-call service and emergency medicine.ConclusionsDespite comparable urgency, the findings suggest variations of intended healthcare utilisation depending on various characteristics of the vignettes and respondents. Depending on the type of disease inequalities vary. Overall, information about healthcare alternatives in severe cases has to be improved and clear pathways to facilitate healthcare utilisation has to be further developed.
20
Ma, Yuanyuan, and Anne Nolan. "Public Healthcare Entitlements and Healthcare Utilisation among the Older Population in Ireland." Health Economics 26, no. 11 (October 3, 2016): 1412–28. http://dx.doi.org/10.1002/hec.3429.
Full text
21
Hasan, Taimoor, Tom S. Ainscough, Jane West, and Lorna Katharine Fraser. "Healthcare utilisation in overweight and obese children: a systematic review and meta-analysis." BMJ Open 10, no. 10 (October 2020): e035676. http://dx.doi.org/10.1136/bmjopen-2019-035676.
Full textAbstract:
ObjectiveThis systematic review and meta-analysis aims to systematically analyse the association of overweight and obesity with health service utilisation during childhood.Data sourcesPubMed, MEDLINE, CINAHL, EMBASE and Web of Science.MethodsObservational studies published up to May 2020 that assessed the impact of overweight and obesity on healthcare utilisation in children and adolescents were included. Studies were eligible for inclusion if the included participants were ≤19 years of age. Findings from all included studies were summarised narratively. In addition, rate ratios (RRs) and 95% CIs were calculated in a meta-analysis on a subgroup of eligible studies.Outcome measuresIncluded studies reported association of weight status with healthcare utilisation measures of outpatient visits, emergency department (ED) visits, general practitioner visits, hospital admissions and hospital length of stay.ResultsThirty-three studies were included in the review. When synthesising the findings from all studies narratively, obesity and overweight were found to be positively associated with increased healthcare utilisation in children for all the outcome measures. Six studies reported sufficient data to meta-analyse association of weight with outpatient visits. Five studies were included in a separate meta-analysis for the outcome measure of ED visits. In comparison with normal-weight children, rates of ED (RR 1.34, 95% CI 1.07 to 1.68) and outpatient visits (RR 1.11, 95% CI 1.02 to 1.20) were significantly higher in obese children. The rates of ED and outpatient visits by overweight children were only slightly higher and non-significant compared with normal-weight children.ConclusionsObesity in children is associated with increased healthcare utilisation. Future research should assess the impact of ethnicity and obesity-associated health conditions on increased healthcare utilisation in children with overweight and obesity.PROSPERO registration numberCRD42018091752
22
Hughes, Lloyd D., and Maggie Keeble. "Investing in social care to reduce healthcare utilisation." British Journal of General Practice 70, no. 690 (December 26, 2019): 4–5. http://dx.doi.org/10.3399/bjgp20x707249.
Full text
23
Spitzer, Sonja, and Mujaheed Shaikh. "Health Misperception and Healthcare Utilisation among Older Europeans." Institut für Demographie - VID 1 (2021): 1–57. http://dx.doi.org/10.1553/0x003cb422.
Full text
24
Spitzer, Sonja, and Mujaheed Shaikh. "Health misperception and healthcare utilisation among older Europeans." Journal of the Economics of Ageing 22 (June 2022): 100383. http://dx.doi.org/10.1016/j.jeoa.2022.100383.
Full text
25
Crémieux, Pierre-Yves, Pierre Ouellette, and Patrick Petit. "Do Drugs Reduce Utilisation of Other Healthcare Resources?" PharmacoEconomics 25, no. 3 (March 2007): 209–21. http://dx.doi.org/10.2165/00019053-200725030-00004.
Full text
26
&NA;. "Utilisation of healthcare services reduced in the uninsured." Inpharma Weekly &NA;, no. 1539 (May 2006): 5. http://dx.doi.org/10.2165/00128413-200615390-00012.
Full text
27
Greenough, A. "Preschool healthcare utilisation related to home oxygen status." Archives of Disease in Childhood - Fetal and Neonatal Edition 91, no. 5 (September 1, 2006): F337—F341. http://dx.doi.org/10.1136/adc.2005.088823.
Full text
28
Sipsma, Heather, Tamora A. Callands, Elizabeth Bradley, Benjamin Harris, Billy Johnson, and Nathan B. Hansen. "Healthcare utilisation and empowerment among women in Liberia." Journal of Epidemiology and Community Health 67, no. 11 (August 8, 2013): 953–59. http://dx.doi.org/10.1136/jech-2013-202647.
Full text
29
Nonoyama, Mika L., Douglas A. McKim, Jeremy Road, Denise Guerriere, Peter C. Coyte, Marina Wasilewski, Monica Avendano, et al. "Healthcare utilisation and costs of home mechanical ventilation." Thorax 73, no. 7 (January 26, 2018): 644–51. http://dx.doi.org/10.1136/thoraxjnl-2017-211138.
Full textAbstract:
BackgroundIndividuals using home mechanical ventilation (HMV) frequently choose to live at home for quality of life, despite financial burden. Previous studies of healthcare utilisation and costs do not consider public and private expenditures, including caregiver time.ObjectivesTo determine public and private healthcare utilisation and costs for HMV users living at home in two Canadian provinces, and examine factors associated with higher costs.MethodsLongitudinal, prospective observational cost analysis study (April 2012 to August 2015) collecting data on public and private (out-of-pocket, third-party insurance, caregiving) costs every 2 weeks for 6 months using the Ambulatory and Home Care Record. Functional Independence Measure (FIM) was used at baseline and study completion. Regression models examined variables associated with total monthly costs selected a priori using Andersen and Newman’s framework for healthcare utilisation, relevant literature, and clinical expertise. Data are reported in 2015 Canadian dollars ($C1=US$0.78=₤0.51=€0.71).ResultsWe enrolled 134 HMV users; 95 with family caregivers. Overall median (IQR) monthly healthcare cost was $5275 ($2291–$10 181) with $2410 (58%) publicly funded; $1609 (39%) family caregiving; and $141 (3%) out-of-pocket (<1% third-party insurance). Median healthcare costs were $8733 ($5868–$15 274) for those invasively ventilated and $3925 ($1212–$7390) for non-invasive ventilation. Variables associated with highest monthly costs were amyotrophic lateral sclerosis (1.88, 95% CI 1.09 to 3.26, P<0.03) and lower FIM quintiles (higher dependency) (up to 6.98, 95% CI 3.88 to 12.55, P<0.0001) adjusting for age, sex, tracheostomy and ventilation duration.ConclusionsFor HMV users, most healthcare costs were publicly supported or associated with family caregiving. Highest costs were incurred by the most dependent users. Understanding healthcare costs for HMV users will inform policy decisions to optimise resource allocation, helping individuals live at home while minimising caregiver burden.
30
Piccinni, Carlo, Giulia Ronconi, Silvia Calabria, Letizia Dondi, Emanuele Forcesi, Elisa Rossi, Antonella Pedrini, and Nello Martini. "Healthcare resources utilisation in primary progressive multiple sclerosis." Neurological Sciences 39, no. 7 (April 10, 2018): 1169–74. http://dx.doi.org/10.1007/s10072-018-3404-4.
Full text
31
Ndarukwa, Pisirai, Moses John Chimbari, and Elopy Sibanda. "Protocol for a scoping review to evaluate the extent of utilisation of healthcare services by asthma patients in sub-Saharan African countries." BMJ Open 11, no. 8 (August 2021): e046294. http://dx.doi.org/10.1136/bmjopen-2020-046294.
Full textAbstract:
IntroductionHealth systems in sub-Saharan African (SSA) countries are fragile and centralised. Consequently, majority of people have restricted access to healthcare services. Given the rise in the prevalence and burden of asthma in SSA, it is imperative to scrutinise the utilisation of healthcare services by people with asthma. We aim to understand, through this review, the extent of utilisation of healthcare services by asthma patients in SSA countries.Methods and analysisArksey and O’Malley’s scoping review methodology framework will be used to guide the conduct of this scoping review. We will conduct a search of the literature on the electronic databases: Medline, (using PubMed interface), EMBASE, EBSCOHOST, Web of Science and Google Scholar, grey literature sources and the reference lists of key studies to identify studies appropriate for inclusion. Two reviewers will independently screen all abstracts and full-text studies for inclusion. Registration of the proposed scoping review on the PROSPERO has indicated that no similar work has been or is being done elsewhere. We will review studies published on the subject from January 2009 to May 2020 in SSA.Ethics and disseminationThe proposed scoping review will contribute towards the knowledge base on utilisation of healthcare services particularly for people with asthma. This will provide a better understanding of the extent of utilisation of healthcare services by asthma patients and ultimately contribute to improvement of quality of care for people suffering from asthma. The results from the review will enlighten and guide healthcare practitioners and researchers on developing appropriate and feasible interventions to increase the utilisation of healthcare services by asthma patients in resource-constrained settings in SSA countries. Results of this scoping review will be disseminated through a peer-reviewed publication, conference presentations and a 1-day stakeholder meeting.PROSPERO registration numberCRD42020154127.
32
Whitney, Daniel, Neil Kamdar, Richard A. Hirth, Edward A. Hurvitz, and Mark D. Peterson. "Economic burden of paediatric-onset disabilities among young and middle-aged adults in the USA: a cohort study of privately insured beneficiaries." BMJ Open 9, no. 9 (September 2019): e030490. http://dx.doi.org/10.1136/bmjopen-2019-030490.
Full textAbstract:
ObjectiveIndividuals with paediatric-onset disabilities (PoDs) have complex healthcare needs and are susceptible to adverse health outcomes, which may impose a higher strain on healthcare resources. The burden of healthcare resource utilisation and costs attributed to the population of adults with PoDs is not clearly established. The objective here was to compare healthcare resource utilisation and costs between adults with versus without PoDs.DesignCohort.SettingData were from the 2016 Optum Clinformatics Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the USA.ParticipantsInternational Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify beneficiaries with PoDs that were between 18 and 64 years of age.Primary and secondary outcome measuresAnnual all-cause healthcare resource utilisation and total healthcare costs were compared between adults with and without PoDs before and after adjusting for sociodemographics and several costly non-communicable diseases.ResultsAdults with PoDs (n=121 446) had greater annual mean counts of service utilisation for all service types (eg, inpatient, outpatient, emergency visits) compared with adults without PoDs (n=5 415 475) before and after adjustments (all p<0.001). Adults with PoDs had greater unadjusted total standardised reimbursement costs (US$26 702 vs US$8464; mean difference=US$18 238; cost ratio (CR)=3.16; 95% CI=3.13 to 3.18) and total patient out-of-pocket costs (US$2226 vs US$1157; mean difference=US$1069; CR=1.88; 95%CI=1.86 to 1.89). After adjustments, total standardised reimbursement costs were 2.32 times higher (95% CI=2.30 to 2.34) and total patient out-of-pocket costs were 1.65 times higher (95% CI=1.64 to 1.66) compared with adults without PoDs.ConclusionAdults with PoDs had greater healthcare utilisation and costs, even after accounting for costly diseases. Future research is needed to identify the cost drivers for adults with PoDs.
33
van der Wielen, Nele, Andrew Amos Channon, and Jane Falkingham. "Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana." BMJ Global Health 3, no. 1 (February 2018): e000590. http://dx.doi.org/10.1136/bmjgh-2017-000590.
Full textAbstract:
IntroductionThis paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed.MethodsUsing the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over.ResultsThe raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled.ConclusionThe results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.
34
Wijga, Alet H., Sigrid M. Mohnen, Judith M. Vonk, and Ellen Uiters. "Healthcare utilisation and expenditure of overweight and non-overweight children." Journal of Epidemiology and Community Health 72, no. 10 (June 11, 2018): 940–43. http://dx.doi.org/10.1136/jech-2017-210222.
Full textAbstract:
BackgroundQuantification of the burden of overweight on the healthcare system is becoming increasingly urgent for health policy, but accurate estimates are hard to obtain.MethodsIn order to assess healthcare utilisation and expenditure of overweight and non-overweight children, we linked, on an individual basis, data on body mass index from a birth cohort study with administrative health insurance claims data. In children aged 14–15 years, we compared utilisation and expenditure on general practice care, dental care, hospital/specialist care, prescribed medication, allied healthcare and mental healthcare of overweight children (overweight at age 11 and 14, n=80) and non-overweight children (no overweight at age 11 and 14, n=1253).ResultsFor overweight children, mean 1-year healthcare expenditure was €837 per child and for non-overweight children €616. This difference was mainly due to significant differences in utilisation of hospital care (49% vs 37%) and mental healthcare (14% vs 7%) and to a lesser extent to higher expenditure per user.ConclusionOur results indicate the potential value of linking survey data to claims data in order to obtain insight into the healthcare costs of childhood overweight. Further studies should elucidate whether the observed differences are causally related to overweight.
35
Yan, Chiu-Lan, Li-Ting Kao, Ming-kung Yeh, Wu-Chien Chien, and Chin-Bin Yeh. "Healthcare utilisation for eating disorders among patients with depression: a cross-sectional study in Taiwan." BMJ Open 9, no. 12 (December 2019): e032108. http://dx.doi.org/10.1136/bmjopen-2019-032108.
Full textAbstract:
ObjectivesAlthough depressed patients may have a comorbid eating disorder (ED), to date, no study has focused on healthcare utilisation among this population. This study was designed to investigate the characteristics of healthcare service utilisation among depressed patients with ED.DesignA cross-sectional study.SettingThis population-based study used claims data from Taiwan’s National Health Insurance Research database between 2001 and 2012.ParticipantsThe study involved 1270 participants. These included 254 depressed individuals with ED and 1016 propensity score-matched depressed individuals without ED.Outcome measuresWe tracked each patient for a 1 year period to evaluate their healthcare service utilisation, including outpatient visits, inpatient days, and costs for psychiatry and non-psychiatry services. We performed a Mann-Whitney U test to compare outcome variables in healthcare service utilisation between the two groups.ResultsPatients with both depression and ED had significantly more outpatient visits (32.2 vs 28.9, p=0.023), outpatient costs (US$1089 vs US$877, p<0.001) and total costs (US$1356 vs US$1296, p<0.001) than comparison patients. For psychiatric services, patients with depression and ED had more outpatient visits (11.0 vs 6.8, p<0.001), outpatient costs (US$584 vs US$320, p<0.001) and total costs (US$657 vs US$568, p<0.001) than those without ED. For non-psychiatric services, there was no significant difference for all utilisation. This indicates that the total costs were about 1.0-fold greater for depression patient with ED than those without ED.ConclusionDepression patients with ED had more outpatient visits, outpatient costs and total costs of healthcare services than those without ED.
36
Brals, Daniella, Heleen Nelissen, Marijn Van der List, Cheikh Faye, Collins Juma, Chris Elbers, Ferdinand Wit, Michael Boele van Hensbroek, and Constance Schultsz. "Impact of the community healthcare plan and the free maternity services programme on maternal and child healthcare utilisation in rural Kenya: a dairy farmer population-based study." African Health Sciences 19, no. 3 (November 6, 2019): 2600–2614. http://dx.doi.org/10.4314/ahs.v19i3.36.
Full textAbstract:
Background: Access to and utilisation of quality maternal and child healthcare services is generally recognized as the best way to reduce maternal and child mortality.Objectives: We evaluated whether the introduction of a voluntary family health insurance programme, combined with quality improvement of healthcare facilities [The Community Health Plan (TCHP)], and the introduction of free access to delivery services in all public facilities [Free Maternity Services programme (FMS)] increased antenatal care utilisation and use of facility deliveries among pregnant women in rural Kenya.Methods: TCHP was introduced in 2011, whilst the FMS programme was launched in 2013. To measure the impact of TCHP, percentage points (PP) changes in antenatal care utilisation and facility deliveries from the pre-TCHP to the post-TCHP period between the TCHP programme area and a control area were compared in multivariable difference-in-differences analysis. To measure the impact of the FMS programme, PP changes in antenatal care utilisation and facility deliveries from the pre-FMS to the post-FMS period in the pooled TCHP programme and control areas was assessed in multivariable logistic regression analysis. Data was collected through household surveys in 2011 and 2104. Households (n=549) were randomly selected from the member lists of 2 dairy companies, and all full-term pregnancies in the 3.5 years preceding the baseline and follow-up survey among women aged 15-49 at the time of pregnancy were eligible for this study (n=295).Results: Because only 4.1% of eligible women were insured through TCHP during pregnancy, any increase in utilisation attributable to the TCHP programme could only have come about as a result of the quality improvements in TCHP facilities. Antenatal care utilisation significantly increased after TCHP was introduced (14.4 PP; 95% CI: 4.5–24.3; P=0.004), whereas no effect was observed of the programme on facility deliveries (8.8 PP; 95% CI: -14.1 to +31.7; P=0.450). Facility deliveries significantly increased after the introduction of the FMS programme (27.9 PP; 95% CI: 11.8–44.1; P=0.001), but antenatal care utilisation did not change significantly (4.0 PP; 95% CI: -0.6 to +8.5; P=0.088).Conclusion: Access to the FMS programme increased facility deliveries substantially and may contribute to improved maternal and new-born health and survival if the quality of delivery services is sustained or further improved. Despite low up-take, TCHP had a positive effect on antenatal care utilisation among uninsured women by improving the quality of existing healthcare facilities. An alignment of the two programmes could potentially lead to optimal results.Funding: The study was funded by the Health Insurance Fund (http://www.hifund.org/), through a grant from the Dutch Ministry of Foreign Affairs.Keywords: Free Maternity Services programme, maternal and child healthcare utilisation rural, Kenya, a dairy farmer population-based study.
37
Lee, Shaun Wen Huey, Sami L. Gottlieb, and Nathorn Chaiyakunapruk. "Healthcare resource utilisation pattern and costs associated with herpes simplex virus diagnosis and management: a systematic review." BMJ Open 12, no. 1 (January 2022): e049618. http://dx.doi.org/10.1136/bmjopen-2021-049618.
Full textAbstract:
ObjectivesLittle is known about the economic burden of herpes simplex virus (HSV) across countries. This article aims to summarise existing evidence on estimates of costs and healthcare resource utilisation associated with genital and neonatal HSV infection.DesignSystematic literature review.Data sourcesSeven databases were searched from inception to 31 August 2020. A focused search was performed to supplement the results.Eligibility criteriaStudies which reported either healthcare resource utilisation or costs associated with HSV-related healthcare, including screening, diagnosis and treatment of genital HSV infection and neonatal herpes prevention and treatment.Data extraction and synthesisTwo independent reviewers extracted data and assessed the risk of bias using the Larg and Moss’s checklist. All data were summarised narratively.ResultsOut of 11 443 articles, 38 were included. Most studies (35/38, 94.6%) were conducted in high-income countries, primarily the United States, and were more often related to the prevention or management of neonatal herpes (n=21) than HSV genital ulcer disease (n=17). Most analyses were conducted before 2010. There was substantial heterogeneity in the reporting of HSV-related healthcare resource utilisation, with 74%–93% individuals who sought care for HSV, 11.6%–68.4% individuals who received care, while neonates with herpes required a median of 6–34 hospitalisation days. The costs reported were similarly heterogeneous, with wide variation in methodology, assumptions and outcome measures between studies. Cost for screening ranged from US$7–100, treatment ranged from US$0.53–35 for an episodic therapy, US$240–2580 yearly for suppressive therapy, while hospitalisation for neonatal care ranged from US$5321–32 683.ConclusionsA paucity of evidence exists on healthcare resource utilisation and costs associated with HSV infection, especially among low-income and middle-income countries. Future research is needed on costs and healthcare utilisation patterns to improve overall understanding of the global economic burden of HSV.
38
Bolin, Kristian. "Physical inactivity: productivity losses and healthcare costs 2002 and 2016 in Sweden." BMJ Open Sport & Exercise Medicine 4, no. 1 (October 2018): e000451. http://dx.doi.org/10.1136/bmjsem-2018-000451.
Full textAbstract:
ObjectivesTo estimate the costs associated with physical inactivity in Sweden for the year 2016.MethodsThe costs associated with insufficient physical activity was calculated employing population attributable fractions (PAFs) and register information on healthcare utilisation, mortality and disability pensions. The PAFs were calculated using information on exercise habits and morbidity-specific relative risks. The healthcare cost components were calculated based on registry data on inpatient-care, outpatient-care and primary care utilisation. Registry data on cause-specific mortality and granted disability pensions were used to calculate the productivity loss components. Costs associated with pharmaceutical utilisation were not included due lack of data.ResultsPhysical exercise habits improved somewhat between 2002 and 2016. Thus, the associated morbidity-specific PAFs decreased over the same time period.ConclusionsThe economic costs attributable to insufficient physical activity decrease between the year 2002 and 2016. Healthcare costs attributable to insufficient physical activity as share of total healthcare expenses increased from 0.86 % in 2002 to 0.91 % in 2016.
39
Akowuah, Jones Asafo, Peter Agyei-Baffour, and Dadson Awunyo-Vitor. "Determinants of Antenatal Healthcare Utilisation by Pregnant Women in Third Trimester in Peri-Urban Ghana." Journal of Tropical Medicine 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/1673517.
Full textAbstract:
Access to quality healthcare still remains a major challenge in the efforts at reversing maternal morbidity and mortality. Despite the availability of established maternal health interventions, the health of the expectant mother and the unborn child remains poor due to low utilisation of interventions. The study examined the socioeconomic determinants of antenatal care utilisation in peri-urban Ghana using pregnant women who are in their third trimester. Two-stage sampling technique was used to sample 200 pregnant women who were in their third trimester from the District Health Information Management System software. Well-structured questionnaire was the instrument used to collect data from respondents. Descriptive statistics and inferential statistics including binary logit regression model were used to analyse the data with the help of SPSS and STATA software. The results showed varying utilisation levels of ANC. From the regression result, age, household size, and occupational status were identified as the important socioeconomic determinants of antenatal care utilisation among the respondents. The important system factors which influence antenatal care utilisation by the respondents are distance to ANC, quality of service, and service satisfaction. The study concludes that socioeconomic and health system factors are important determinants of antenatal care utilisation. Stepping up of interventions aimed at improving the socioeconomic status and addressing health system and proximity challenges could be helpful in improving antenatal care utilisation by pregnant women in Ghana.
40
Howarth, Ana, Morag Munro, Alf Theodorou, and Peter R. Mills. "Trends in healthcare utilisation during COVID-19: a longitudinal study from the UK." BMJ Open 11, no. 7 (July 2021): e048151. http://dx.doi.org/10.1136/bmjopen-2020-048151.
Full textAbstract:
ObjectiveThe first wave of the COVID-19 pandemic had a major impact on healthcare utilisation. The aim of this retrospective review was to quantify how utilisation of non-COVID care changed during this time so as to gain insight and inform planning of future services during potential second and subsequent waves.Methods and analysisA longitudinal design was used to analyse anonymous private UK health insurer datasets covering the period of January 2018 to August 2020. Taken as a measure of healthcare utilisation in the UK, incidence rates of claims broken down by service area and condition were calculated alongside overall monthly totals and costs. Pre-COVID-19 years were compared with the current year.ResultsHealthcare utilisation during the first wave of COVID-19 decreased by as much as 70% immediately after lockdown measures were implemented. After 2 months, the trend reversed and claims steadily began to increase, but did not reach rates seen from previous years by the end of August 2020. Assessment by service and diagnostic category showed that most areas, especially those highly reliant on in-person treatment, reflected the same pattern (ie, rapid drop followed by a steady recovery). The provision of mental health services differed from this observed trend, where utilisation increased by 20% during the first wave of COVID-19, in comparison to pre-COVID-19 years. The utilisation of maternity services and the treatment of existing cancers also stayed stable, or increased slightly, during this time.ConclusionsHealthcare utilisation in a UK-based privately insured population decreased dramatically during the first wave of the COVID-19 pandemic, being over 70% lower at its height. However, mental health services remained resilient during this time, possibly due to greater virtualisation of diagnostics and care.
41
Morgans, Amee, and Stephen Burgess. "Judging a patient's decision to seek emergency healthcare: clues for managing increasing patient demand." Australian Health Review 36, no. 1 (2012): 110. http://dx.doi.org/10.1071/ah10921.
Full textAbstract:
Objective. In recent years, the concept of an ‘inappropriate’ emergency department or ambulance user has arisen. This discussion paper explores definition and measurement of inappropriate emergency healthcare utilisation, and the effect on demand. Method. A comprehensive literature review of published articles was conducted. Results. Exploration of the definitions of ‘inappropriate’ emergency healthcare utilisation identified two patient cohorts; emergency healthcare utilisation by those who are not experiencing a health emergency, and those who do not seek emergency healthcare who should. Several position papers from Australian and international sources emphasised the patient’s right to access emergency healthcare when they feel the need, and the responsibility of emergency healthcare workers to provide treatment to all patients. Differences between medical classifications of urgency based on physiological measures are contrasted with patient-based determination of urgency, which is defined by psychosocial factors. Conclusions. This literature review raises questions about patients’ understanding of the role of emergency healthcare services in an emergency. This has implications for determining the patient’s point of access to the health system in an acute health event, and offers an opportunity to selectively educate patients and carers to change help-seeking behaviours to suit the health system resources and moderate patient demand. What is known about the topic? There is a public health issue where some patients seek emergency healthcare when they are not acutely unwell (inappropriate health service users) and some patients who fail to seek emergency healthcare when they are acutely unwell (patients who ‘delay’ or avoid using emergency health services). There is a difference in understanding between health professionals and patients about what a health emergency is and when it is appropriate to seek emergency healthcare. There is an increasing demand for emergency health services both nationally and internationally. What does this paper add? This paper provides a review of Australian and international rates of ‘inappropriate’ healthcare utilisation. This paper identifies the limitations on the ability to determine whether patients were appropriate or inappropriate, and instead identifies what motivates patients to seek emergency healthcare for non-acute events and fail to seek healthcare for acute events. What are the implications for practitioners? There is a high demand for health services, which is increasing, and understanding patient motivations to seek healthcare may assist the development of demand management strategies. This paper will enhance practitioner understanding of patient motivation to seek emergency healthcare. This paper concludes with educational information that practitioners can use to change patient healthcare utilisation patterns.
42
Davies, Emma, Ceri J. Phillips, Mari Jones, and Bernadette Sewell. "Healthcare resource utilisation and cost analysis associated with opioid analgesic use for non-cancer pain: A case-control, retrospective study between 2005 and 2015." British Journal of Pain 16, no. 2 (November 3, 2021): 243–56. http://dx.doi.org/10.1177/20494637211045898.
Full textAbstract:
Objective To examine differences in healthcare utilisation and costs associated with opioid prescriptions for non-cancer pain issued in primary care. Method A longitudinal, case-control study retrospectively examined Welsh healthcare data for the period 1 January 2005–31 December 2015. Data were extracted from the Secure Anonymised Information Linkage (SAIL) databank. Subjects, aged 18 years and over, were included if their primary care record contained at least one of six overarching pain diagnoses during the study period. Subjects were excluded if their record also contained a cancer diagnosis in that time or the year prior to the study period. Case subjects also received at least one prescription for an opioid analgesic. Controls were matched by gender, age, pain-diagnosis and socioeconomic deprivation. Healthcare use included primary care visits, emergency department (ED) and outpatient (OPD) attendances, inpatient (IP) admissions and length of stay. Cost analysis for healthcare utilisation used nationally derived unit costs for 2015. Differences between case and control subjects for resource use and costs were analysed and further stratified by gender, prescribing persistence (PP) and deprivation. Results Data from 3,286,215 individuals were examined with 657,243 receiving opioids. Case subjects averaged 5 times more primary care visits, 2.8 times more OPD attendances, 3 times more ED visits and twice as many IN admissions as controls. Prescription persistence over 6 months and greater deprivation were associated with significantly greater utilisation of healthcare resources. Opioid prescribing was associated with 69% greater average healthcare costs than in control subjects. National Health Service (NHS) healthcare service costs for people with common, pain-associated diagnoses, receiving opioid analgesics were estimated to be £0.9billion per year between 2005 and 2015. Conclusion Receipt of opioid prescriptions was associated with significantly greater healthcare utilisation and accompanying costs in all sectors. Extended prescribing durations are particularly important to address and should be considered at the point of initiation.
43
Ferguson, Jamie, Myriam Alexander, Stuart Bruce, Matthew O'Connell, Sue Beecroft, and Martin McNally. "A retrospective cohort study comparing clinical outcomes and healthcare resource utilisation in patients undergoing surgery for osteomyelitis in England: a case for reorganising orthopaedic infection services." Journal of Bone and Joint Infection 6, no. 5 (April 28, 2021): 151–63. http://dx.doi.org/10.5194/jbji-6-151-2021.
Full textAbstract:
Abstract. Aims: An investigation of the impact of a multidisciplinary bone infection unit (BIU) undertaking osteomyelitis surgery with a single-stage protocol on clinical outcomes and healthcare utilisation compared to national outcomes in England. Patients and Methods: A tertiary referral multidisciplinary BIU was compared to the rest of England (ROE) and a subset of the 10 next busiest centres based on osteomyelitis treatment episode volume (Top Ten), using the Hospital Episodes Statistics database (HES). A total of 25 006 patients undergoing osteomyelitis surgery between April 2013 and March 2017 were included. Data on secondary healthcare resource utilisation and clinical indicators were extracted for 24 months before and after surgery. Results: Patients treated at the BIU had higher orthopaedic healthcare utilisation in the 2 years prior to their index procedure, with more admissions (p< 0.001) and a mean length of stay (LOS) over 4 times longer than other groups (10.99 d, compared to 2.79 d for Top Ten and 2.46 d for the ROE, p< 0.001). During the index inpatient period, the BIU had fewer mean theatre visits (1.25) compared to the TT (1.98, p< 0.001) and the ROE (1.64, p= 0.001). The index inpatient period was shorter in the BIU (11.84 d), 33.6 % less than the Top Ten (17.83 d, p< 0.001) and 29.9 % shorter than the ROE (16.88 d, p< 0.001). During follow-up, BIU patients underwent fewer osteomyelitis-related reoperations than Top Ten centres (p= 0.0139) and the ROE (p= 0.0137). Mortality was lower (4.71 %) compared to the Top Ten (20.06 %, p< 0.001) and the ROE (22.63 %, p< 0.001). The cumulative BIU total amputation rate was lower (6.47 %) compared to the Top Ten (15.96 %, p< 0.001) and the ROE (12.71 %, p< 0.001). Overall healthcare utilisation was lower in the BIU for all inpatient admissions, LOS, and Accident and Emergency (A&E) attendances. Conclusion: The benefits of managing osteomyelitis in a multi-disciplinary team (MDT) specialist setting included reduced hospital stays, lower reoperation rates for infection recurrence, improved survival, lower amputation rates, and lower overall healthcare utilisation. These results support the establishment of centrally funded multidisciplinary bone infection units that will improve patient outcomes and reduce healthcare utilisation.
44
Wong, Jessica J., Pierre Côté, Andrea C. Tricco, and Laura C. Rosella. "Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study." BMJ Open 9, no. 9 (September 2019): e031749. http://dx.doi.org/10.1136/bmjopen-2019-031749.
Full textAbstract:
IntroductionLow back pain (LBP) is a leading cause of disability associated with high healthcare utilisation and costs. Mental health symptoms are negative prognostic factors for LBP recovery; however, no population-based studies have assessed the joint effects of LBP and mental health symptoms on healthcare utilisation. This proposed study will characterise the health system burden of LBP and help identify priority groups to inform resource allocation and public health strategies. Among community-dwelling adult respondents of five cycles of the Canadian Community Health Survey (CCHS) in Ontario, we aim to assess the effect of self-reported LBP on healthcare utilisation and costs and assess whether this effect differs between those with and without self-reported mental health symptoms.Methods and analysisWe designed a dynamic population-based cohort study using linkages of survey and administrative data housed at ICES. The Ontario sample of CCHS (2003–2004, 2005–2006, 2007/2008, 2009/2010, 2011/2012; total of ~1 30 000 eligible respondents) will be used to define the cohort of adults with self-reported LBP with and without mental health symptoms. Healthcare utilisation and costs will be assessed by linking health administrative databases. Follow-up ranges from 6 to 15 years (until 31 March 2018). Sociodemographic (eg, age, sex, education) and health behaviour (eg, comorbidities, physical activity) factors will be considered as potential confounders. Poisson and linear (log-transformed) regression models will be used to assess the association between LBP and healthcare utilisation and costs. We will assess effect modification with mental health symptoms on the additive and multiplicative scales and conduct sensitivity analyses to assess the impact of misclassification and residual confounding.Ethics and disseminationThis study is approved by the University of Toronto Research Ethics Board. We will disseminate findings using a multifaceted knowledge translation strategy, including scientific conference presentations, publications in peer-reviewed journals and workshops with key knowledge users.
45
Mulyanto, Joko, Dionne S. Kringos, and Anton E. Kunst. "Socioeconomic inequalities in healthcare utilisation in Indonesia: a comprehensive survey-based overview." BMJ Open 9, no. 7 (July 2019): e026164. http://dx.doi.org/10.1136/bmjopen-2018-026164.
Full textAbstract:
ObjectiveMonitoring inequality in healthcare utilisation is essential to reduce persistent inequalities in health in lower-middle income countries. This study aimed to assess socioeconomic inequalities in the utilisation of primary care, secondary care and preventive care in Indonesia.MethodsA cross-sectional study was conducted using data from the 2014 Indonesia Family Life Survey with a total of 42 083 adult participants. Socioeconomic status (SES) was measured by educational level and income. Healthcare utilisation was measured in: (1) primary care, (2) outpatient in secondary care, (3) inpatient care and (4) cardiovascular-related preventive care. The magnitude of inequalities was measured using the relative index of inequality (RII).ResultsSmall educational inequalities were found for primary care utilisation (RII 1.13, 95% CI 1.01 to 1.26). Larger educational inequalities were found for outpatient secondary care (RII 10.35, 95% CI 8.11 to 13.22) and inpatient care (RII 2.78, 95% CI 2.32 to 3.32). The largest educational inequalities were found for preventive care, particularly regarding blood glucose tests (RII 30.31, 95% CI 26.13 to 35.15) and electrocardiography tests (RII 30.90, 95% CI 24.97 to 38.23). Compared with educational inequalities, income inequalities were larger for primary care (RII 1.68, 95% CI 1.52 to 1.85) and inpatient care (RII 3.11, 95% CI 2.63 to 3.66), but not for outpatient secondary care and preventive care.ConclusionsSocioeconomic inequalities in healthcare utilisation in Indonesia are particularly large in secondary and preventive care. Therefore, it is recommended to prioritise policies focused on improving timely, geographical and financial access to secondary and preventive care for lower SES groups.
46
Hennelly, Niamh, Georgia Lalor, Sarah Gibney, Rose Anne Kenny, and Mark Ward. "A cross-sectional study of the relationship between delayed healthcare utilisation and chronic conditions among older adults during the COVID-19 pandemic in Ireland." HRB Open Research 4 (October 13, 2021): 112. http://dx.doi.org/10.12688/hrbopenres.13336.1.
Full textAbstract:
Background: Many healthcare services were cancelled or postponed during the coronavirus 2019 (COVID-19) pandemic, likely impacting the management of chronic conditions prevalent among older adults in Ireland. Methods: Data from the Irish Longitudinal Study on Ageing COVID-19 study and previous waves were used. Taking healthcare demand into account, the relationship between delayed healthcare utilisation among older adults (≥50) with chronic conditions was examined. Further analyses examined the reasons for delays in healthcare utilisation, and whether they were the result of the reduced availability of healthcare services or participant decisions. Results: In total, 31.6% of participants reported experiencing healthcare delay. The first analysis found that older adults with two or more chronic conditions were more likely to have experienced healthcare delay than those with no chronic conditions (odds ratio (OR): 1.46, 95% confidence interval (CI): 1.11, 1.90). The second analysis found that older adults with two or more chronic conditions were more likely to have healthcare delayed by the provider (OR: 1.73, 95% CI: 1.16, 2.56), and were also more likely to delay their own healthcare (OR: 1.62, 95% CI: 1.14, 2.29) than older adults with no chronic conditions. Additionally, people aged 70 years and over, females, those with problematic alcohol consumption, those with third-level education, those who had visited the GP and those who reported polypharmacy were all more likely to experience healthcare delay, while older adults living with others and those living outside Dublin were less likely to experience healthcare delay. Conclusion: COVID-19 has had a significant impact on the healthcare utilisation of older adults in Ireland, with some groups of older adults impacted more than others. Policy and practice must now focus on how the healthcare needs of these groups can be best served. Further research is required to understand the impact of healthcare delays on health outcomes.
47
Nedumannil, Leya, Sukhdeep Steven Cheema, Karl Vaz, Ronald Ma, Daryl Jones, Stephen Warrillow, Josephine Grace, Darren Wong, and Matthew Choy. "COVID-19 pandemic impact on alcoholic hepatitis healthcare utilisation." Journal of Hepatology 77 (July 2022): S134. http://dx.doi.org/10.1016/s0168-8278(22)00649-3.
Full text
48
Wu, Tai-Yin, Sheng-Huang Hsiao, Sheng-Jean Huang, Kuan-Liang Kuo, Lin-Chung Woung, and Fang-Chun Chen. "The effect of home visits on healthcare resource utilisation." Australian Journal of General Practice 50, no. 8 (August 1, 2021): 595–602. http://dx.doi.org/10.31128/ajgp-07-20-5512.
Full text
49
Abu Bakar, Nurul Salwana, Adilius Manual, and Jabrullah Ab Hamid. "Socioeconomic Status Affecting Inequity of Healthcare Utilisation in Malaysia." Malaysian Journal of Medical Sciences 26, no. 4 (August 29, 2019): 79–85. http://dx.doi.org/10.21315/mjms2019.26.4.9.
Full text
50
Drysdale, Simon B., Mireia Alcazar-Paris, Theresa Wilson, Melvyn Smith, Mark Zuckerman, Simon Broughton, Gerrard F. Rafferty, Janet L. Peacock, Sebastian L. Johnston, and Anne Greenough. "Rhinovirus infection and healthcare utilisation in prematurely born infants." European Respiratory Journal 42, no. 4 (April 5, 2013): 1029–36. http://dx.doi.org/10.1183/09031936.00109012.
Full text