Access and cost of services for autistic children and adults in Italy: a carers' perspective.

Background: Limited information exists on autistic service access and costs in Italy. Objectives: This study aims to investigate access to educational, healthcare, social, and related services for autistic individuals in Italy as part of the Autism Spectrum Disorder in the European Union (ASDEU) project. Methods: Italian carers of autistic individuals completed an online survey regarding services and costs in the 6 months before completion. Results: Three hundred and three carers of autistic people participated in the survey. The majority of those receiving care were children, males, and lived at home with their parents. Autistic adults were often students (17%) or unemployed but willing to work (17%). Employed carers (49%) worked on average 32.23 ± 9.27 hours per week. A significant portion (82%) took work or school absences to care for autistic individuals, averaging 15.56 ± 14.70 days. On average, carers spent 58.84 ± 48.36 hours per week on caregiving duties. Fifty-five of the autistic individuals received some form of support, 5% utilized residential care, and 6% were hospitalized. Thirty-four percent received outpatient hospital care, and 20% underwent some form of autism-related psychopharmacological therapy. School support was primarily provided by support teachers (18.16 ± 7.02 hours/week). Educational psychologists (80.73%), psychomotor therapists/physiotherapists (53.85%), and speech therapists (50.91%) were frequently paid by carers who paid more per hour. Autistic children received support from educators (73.96 hours/week), group therapy (32.36 hours/week), and speech therapists (31.19 hours/week). Psychologists (76.00%) and counseling/individual therapists (89.13%) were often paid by carers. Carers reported high costs for psychiatrists and psychologists, with frequent use of psychiatric services (8 ± 8 times in 6 months). Conclusions: Carers' perspectives on the access and costs of services for autistic individuals in Italy can provide insights into areas for improvement in the delivery of autism services.

Factors associated with mental health service use during the pandemic: Initiation and barriers.

BACKGROUND: Scarce are the studies focusing on initiation of new mental health service use (MHSU) and distinguishing individuals who have sought services but have been unsuccessful in accessing these. AIMS: Assessing the factors associated with initiating new MHSU as compared to no MHSU due to self-reported no need, no MHSU due to health system and personal barriers and MHSU using resources already in place. METHODS: The sample included participants (n = 16,435) in the five established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) who responded to the CanPath COVID-19 health surveys (May-December 2020 and January-June 2021). Multinomial regression analyses were carried out to study MHSU since the pandemic (March 2020) as a function of predisposing, enabling and need factors. Analyses were carried out in the overall sample and restricted to those with moderate and severe symptoms (MSS) of depression and/or anxiety (n = 2,237). RESULTS: In individuals with MSS of depression and/or anxiety, 14.4% reported initiating new MHSU, 22.0% had no MHSU due to barriers and personal reasons and 36.7% had no MHSU due to self-reported no need. Age, living alone, lower income, a decrease in income during the pandemic and health professional status were associated with MHSU. Younger adults were more likely to initiate MHSU during the pandemic than older adults who reported not being comfortable to seek mental health care or self-reported no need. Individuals living alone and with lower income were more likely to report not being able to find an appointment for mental health care. CONCLUSIONS: Awareness campaigns focusing on older adults that explain the importance of seeking treatment is needed, as well as sensitising health professionals as to the importance of informing and aiding individuals at risk of social isolation and lower socio-economic status as to available mental health resources and facilitating access to care.

Investigating the Rate of the Use of Persian Traditional Medicine Services in Tehran.

Background: Despite all the advancements and publicity made in regard to classical medicine, every day more and more people are interested in complementary medicine. This study was designed and conducted to determine the relative frequency of the use of Persian traditional medicine services by the people of Tehran. Methods: This cross-sectional study was conducted using the telephone survey method in Tehran. A total of 1824 samples were included in the study based on Cochran's formula. At first, by searching databases, including Google Scholar, PubMed, Embase, and internal sources, including the Iran Medex database, numerous medical texts and articles were reviewed in the field of using traditional medicine services. Then, interview guide questions were designed and asked over the phone. Finally, the data were extracted and subjected to quantitative analysis. Frequency and percentage of relative frequency were used to describe the study data. Results: In the study, 62% (n = 1131) of the participants were women, and 60.5% (n = 1103) of the participants have turned to modern medicine for treatment and have also used traditional medical treatments. Also, 43.5% (n = 864) of the participants have used herbal medicines and their products; 43% (n = 616) of the participants have used Persian traditional medicine treatments as self-treatment based on their personal information; and only 46.5% (n = 666) have evaluated the therapeutic effect of Persian traditional medicine methods as "good." Conclusion: The results of the study indicate the need for more emphasis on Persian traditional medicine alongside modern medicine, more organization and supervision of traditional medicine service providers in the country, and the creation of coherent and integrated management in this field.

Factors affecting the use of dental services among Arab children in Israel: a qualitative study.

BACKGROUND: In 2010, Israel reformed its hitherto dominantly privately financed dental services and included preventative and restorative dental care for children in the publicly-funded basket of healthcare services. A survey conducted by Brookdale Institute, found that only 67% of low-income Israeli-Arab children were using the new service (compared to 85% of Jewish children) while the majority of others continue using privately funded services. The aim of this study is to explore and explain Israeli-Arab children's low utilization of publicly-funded preventive and restorative dental care. METHODS: A qualitative study designed to describe and understand the parents' motivations and choices. As a preliminary stage, eight semi-structured interviews were conducted with directors of HMO dental departments and Israeli-Arab dentists. In the second stage, ten one-on-one interviews with parents, and five focus group discussions with 55 parents held on February-March 2017. All discussions in the focus groups were conducted in Arabic and each group was moderated by one of the research team accompanied by another person who documented and recorded the discussion. All interviews and discussions were recorded, transcribed in full and translated into Hebrew. RESULTS: The prevalent attitude is that one goes to the dentist only when there is a serious problem. The importance of preventive care is not appreciated. A childhood fear of the drill is very remembered and passed onto the children. Social and cultural factors such as kinship with service providers (GPs and dentists) influence the choice and utilization of health services. Economic barriers are still existing since even the small co-payment is daunting to low-income parents of large families. Provision of the public service is inadequate in some Arab villages. CONCLUSIONS: The extension of Israel's National Health Insurance Law's basket of services to include dental care for children, while important, is not sufficiently embraced by Israeli Arab children. The remaining barriers include poor living conditions, low educational level that requires very clear sharing of information about the new service, and the resistance of cultural and social traditions. Public dental services providers should focus on conveying relevant oral health messages to the parents too, either through their children or directly.

Fatiga, calidad de vida y utilización de recursos sanitarios en niñoscon enfermedades crónicas complejas / Fatigue, quality of life and health resource utilisation in children with complex chronic diseases

Fundamento: Nuestro objetivo fue determinar la fatiga en niños con enfermedades crónicas complejas (NECC) y analizar su asociación con características clínicas, sociodemográficas, utilización de servicios de salud y calidad de vida. Material y método: Estudio transversal realizado en NECC atendidos en un hospital terciario durante 2016. Se determinaron la fatiga (cuestionario PedsFacit-F) y la calidad de vida (cuestionario PedsQL), y se recogieron las variables uso de recursos sanitarios, grupo de enfermedad, tiempo con la enfermedad, y nivel de estudios y ocupación profesional de los progenitores. Se elaboró un modelo de regresión múltiple para predecir el uso de recursos. Resultados: Se incluyeron 70 niños, edad media 10,5 años (rango: 8-17), 41,4% niñas; la enfermedad oncológica fue la más frecuente (28,6%). El uso anual de recursos sanitarios (38,86; DE: 30,73) aumentó con la fatiga (r=-0,292; p=0,015). Las enfermedades oncológicas causaron más fatiga (24,9; DE: 10,7) que otras patologías y las cardiológicas menos (44,5; DE: 7,9). La calidad de vida percibida por NECC (20,6; DE: 16,5) correlacionó directa y significativamente (p<0,001) con la de sus progenitores (22,8; DE: 16,8); ambas se correlacionaron con la fatiga (r=0,528 y r=0,441; p<0,0001). El modelo de regresión lineal mostró que el efecto ajustado de mayor fatiga (menor puntuación), menor tiempo con la enfermedad y mayor nivel de estudios de la madre predijeron mayor uso de recursos de salud. Conclusión: Los NECC con mayor fatiga hacen mayor uso de los recursos sanitarios, y perciben una peor calidad de vida, aspectos que deberían tenerse en cuenta a la hora de prestar atención a esta población.(AU)

Background: The objective was to assess fatigue in children with complex chronic diseases (CCCDs) and analyze its relationship with clinical and sociodemographic characteristics, use of health care services, and quality of life (QoL). Methods.: Cross-sectional study carried out in CCCDs attended in atertiary hospital during 2016. Fatigue (PedsFacit-F questionnaire) and quality of life (PedsQL) were determined, and the following variables were registered: use of health resources, disease group, time with disease, and educational level and type of employment of the parents. A multiple regression model was developed to predict the use of healthcare resources. Results: Seventy children were included in this study; mean age 10.5 years (range: 8-17), 41.4% girls, and cancer was the most frequent group disease (28.6%). Annual use of healthcare resources (38.86; SD: 30.73) increased with fatigue (r= -0.292; p= 0.015). High-er levels of fatigue were determined for children with cancer (24.9; SD: 10.7) in comparison to other pathologies, while lower levels were found for heart diseases (44.5; SD: 7.9). The QoL perceived by CCCDs (20.6; SD: 16.5) directly correlated (p <0.001) with that of their parents (22.8; SD: 16.8); a correlation with fatigue was seen in both cases (r= 0.528 and r= 0.441; p <0.0001). The adjusted effect of higher levels of fatigue (lower scores), lower length of diseaseduration, and higher level of education of the mother, predicted greater use of healthcare resources. Conclusion: CCCDs with higher fatigue levels use healthcare resources more often and perceive a worse QoL. This should be con-sidered when providing care to this population.(AU)

The impact of dental Medicaid reform on dental care provider activity and market penetration of dental support organizations.

BACKGROUND: Medicaid state dental programs have experienced changes related to provider practice settings with the increased growth of dental support organizations (DSOs). The authors conducted this study to assess the impact of state Medicaid reform on the dental practice environment by examining provider activity and practice setting. METHODS: This was a retrospective cohort study of more than 13 million dental claims in the Virginia Medicaid program. It included children and dental care providers in the Virginia dental Medicaid program at some time during a 9-year period (fiscal years 2003-2011). The independent variable was the provider practice setting: private practice, DSO, and safety-net practice. The outcomes included annual measures of claims, patients, and payments per provider. The outcomes were examined over 3 phases of the study period: prereform (2003-2005), implementation phase (2006-2008), and postreform maturation (2009-2011). RESULTS: Provider activity increased after dental program reform, with private-practice providers delivering most of the dental care in the Medicaid program. There was a significant penetration of DSO providers in number of providers, claims per provider, and patients per provider (P < .001). Regression results found that providers in DSO settings had an increased number of patients and claims compared with private-practice providers. CONCLUSIONS: Medicaid reform has resulted in a significant increase in provider participation and growth of DSO-affiliated providers. PRACTICAL IMPLICATIONS: Areas of the state with more dense population had a higher penetrance of dentists practicing in DSO settings providing dental services to children enrolled in Medicaid.

Predictors of community mental health nursing services use in Switzerland: Results from a representative national survey.

Community mental health services are the service of choice in the mental health field. In recent years, demand for these services has increased significantly. Nurses play a central role in community mental health services. Nevertheless, predictive factors of the use of such services are unclear, especially in Switzerland. This study aimed to examine relevant predictors of persons with mental health problems' use of community mental health nursing services in Switzerland. Swiss Health Survey 2017 data were used to compare those who use community mental health nursing services with those who do not. We found that age, number of doctor visits, problems with instrumental activities of daily life, use of informal help, use of emergency services, taking psychotropic medication, being female, and living without a partner were positive predictors, while experiencing severe physical symptoms was a negative predictor. Several of our findings confirm the similarity between the utilization of community mental health nursing services and the use of community mental health services in general. Our results suggest that community mental health nursing services deserve the same prominent place in the mental health system and its corresponding policies. This should be taken as an argument for policy development and better reimbursement. In research, health surveys should focus on nursing and need-related questions. Additionally, it is necessary to develop community mental health nursing services from an add-on service into independent nursing services and evaluate these services.

Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level.

BACKGROUND: Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services. METHODS: This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done. RESULTS: A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76-85 years old, it was 22.1 (SD = 20.3); and in people 66-75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2-0.4), high risk level (BC = 1.9; 95%CI =0.4-3.2), weight of complexity (BC = 0.7; 95%CI = 0.5-0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3-1.1). CONCLUSIONS: In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

Changing Dental Profession-Modern Forms and Challenges in Dental Practice.

In the last two decades, an increasing trend towards new forms of dental practice was observed [...].

Monetary value of informal caregiving in dementia from a societal perspective.

BACKGROUND: Dementia is a condition which results in a high cost of care, a significant proportion of which is the cost associated with informal care. In previous studies, informal caregiving has been challenging to assess due to difficulties in estimating the true time spent on caregiving work and how to value caregivers' time. The aim of this study was to compare the costs of dementia among patients living alone and among those living with a caregiver to show the monetary value of informal caregiving from a societal perspective. METHODS: Data from our four dementia trials using the same measures were combined, allowing the inclusion of 604 participants. Participants were followed up for 2 years or until death for their use of health and social services. Use of all services was retrieved from medical/social records. We also included the costs of lost productivity of those caregivers who were not retired. RESULTS: The total mean cost of services and lost productivity was €22,068/person-year (pyrs). Participants living alone had a mean cost of €45,156/pyrs, whereas those living with a spouse had a mean cost of €16,416/pyrs (mean cost ratio 2.99, 95% confidence interval 2.64-3.39). Participants living alone and having <15 Mini-Mental State Examination points had higher costs than people with dementia in institutional care. CONCLUSIONS: Detailed data of service use and characteristics of people with dementia showed that from a societal perspective, living alone is a very strong determinant of service use in dementia. Informal caregivers do invaluable work for society.

Organization of Community Psychiatric Services in Finland.

Background: The Finnish psychiatric treatment system has undergone a rapid transformation from operating in institutional settings to a adopting a community-based approach, through implementation of national plans; this process was carried out quickly, due to a severe economic recession in the early 1990s. Methods: This paper is a narrative review, based on relevant documents by national authorities, academic dissertations and published scientific literature, between 1984 and 2018, as well as the interviews of key experts in 2019. Results: The municipality is currently the primary organization, responsible for all health services. Municipalities may also work together in organizing the services, either through unions of municipalities or hospital districts. Services are to a great extent outpatient-oriented. The number of beds is one fifth of the previous number, around four decades ago, despite the increase in population. In 2017, 191,895 patients in total (4% of Finns) had used outpatient psychiatric services, and the number of visits totalled 2.25 million. Psychotherapy is mainly carried out in the private sector by licensed psychotherapists. Homelessness in relation to discharged psychiatric patients has not been in evidence in Finland and deinstitutionalization has not caused an increase in the mortality rate among individuals with severe mental disorders. Conclusion: Psychiatric patients have, in general, benefitted greatly from the shift from institutions to the community. This does not preclude the fact that there are also shortcomings. The development of community care has, to date, focused too heavily on resource allocation, at the expense of strategic planning, and too little on methods of treatment.

Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors.

BACKGROUND: Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners. METHODS: A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed. RESULTS: A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners. CONCLUSIONS: The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.

[Mutual health insurance in Bukavu in the Democratic Republic of the Congo: factors favouring the utilization of health services by adherents]. / Mutuelles de santé à Bukavu en République Démocratique du Congo: facteurs favorables à l'utilisation des services de santé par des adhérents.

INTRODUCTION: This study highlights the determinants of the use of health services by adherents to the three mutual health insurances in the town of Bukavu in the Democratic Republic of the Congo. METHODS: We conducted a descriptive cross-sectional study, based on a perception survey among users of healthcare services affiliated to the mutual health insurances in the Bukavu health zones. The encoding and statistical analysis were carried out using the Epi INFO version 2010 software. RESULTS: The main determinants of the use of healthcare services by adherents to the mutual health insurances are: the member's place of residence, the level of education of the head of household, the previous experience of care in the healthcare structure partner of the mutual health insurances, the reputation of the structure partner of the mutual health insurances and the ability of households to pay the user fee. CONCLUSION: This study highlights that, beyond the financial barrier, the implementation of a mutual health organisation should promote a better regulation of the user fee and a good quality of care to meet the care needs of members. The factors emerging from the study as a major determinant of the use of health services by adherents to a mutual health insurance are often not taken into account in the implementation of mutual health insurance in contexts similar to those of Bukavu.

Use of dental services among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

BACKGROUND: This study examines last dental visit (visiting within the last 12 months, having a last visit 5 or more years ago, attending a private dental practice) and usual visit (usually visiting for a check-up, having a dentist they usually attend). METHODS: Explanatory variables include age, gender, region, income, area-based SES and dental insurance. The data were collected in the Interview in NSAOH 2017-18. RESULTS: There was a dental visiting gradient by region, with lower percentages visiting in the last 12 months in remote (44.9%) and regional areas (50.8%) than major cities (58.7%). A higher percentage of the higher-income tertile made visits (63.8%) than the middle (53.7%) and lower tertiles (49.9%). There was a visiting gradient by area-based SES, with higher percentages in the higher (63.8%) and middle SES tertiles (55.2%) than the lower tertile (50.2%). Uninsured persons had lower percentages visiting (43.3%) than insured (69.7%). CONCLUSIONS: Persons in remote locations, those with low socioeconomic status and those uninsured were disadvantaged in terms of access. They had lower percentages visiting in the last 12 months, usually visiting for a check-up, having a dentist they usually attend and higher percentages visiting 5 or more years ago.

Oral hygiene behaviours among Australian adults in the National Study of Adult Oral Health (NSAOH) 2017-18.

BACKGROUND: This paper examines oral hygiene behaviours (tooth brushing, mouthwash use and dental floss) by a range of explanatory variables. METHODS: Explanatory variables included age, sex, region, income, area-based SES, dental insurance and visiting pattern. The data reported were collected in the interview survey in NSAOH 2017-18. RESULTS: A higher percentage of females brushed with toothpaste at least daily (98.0%) and used floss in the last week (62.6%) than males (94.6% and 48.5% respectively). There was an income gradient in tooth brushing. Higher percentages brushed in the high income (96.8%) than middle (96.2%) and low-income tertiles (93.6%). A higher percentage of the high-income tertile (58.2%) flossed than the lower tertile (53.3%). Those with unfavourable visit patterns had lower percentages who brushed daily (92.7%) than the intermediate (96.7%) or favourable (98.2%) groups. There was a gradient in flossing by visiting, with a lower percentage flossing for the unfavourable visiting group (38.5%) than for the intermediate (52.8%) or favourable groups (67.6%). CONCLUSIONS: Oral hygiene behaviours were associated with gender, socioeconomic status and dental visiting. A higher percentage of women brushed and flossed than men. Lower socioeconomic status and those with unfavourable visiting patterns had lower frequencies of brushing and flossing.

Benefits of Teledermatology for Geriatric Patients: Population-Based Cross-Sectional Study.

BACKGROUND: Teledermatology is a health care tool that has been increasingly used around the world, mostly because dermatology has an emphasis on visual diagnosis. Many studies have shown that access to specialized care improves using teledermatology, which provides accurate diagnosis and reduces the time taken for treatment, with high patient satisfaction. As the population around the world grows old, there will be even more demand for dermatologists in years to come. It is essential to know which are the most prevalent skin conditions in the primary care population and if they can be addressed through teledermatology. OBJECTIVE: Our main goal was to evaluate the proportion of lesions in individuals aged 60 years and older that could be managed using teledermatology in conjunction with primary care physicians. Second, we aimed to assess the most frequent skin lesions, the most common treatments provided to patients, and the distribution and causes of referrals made by the teledermatologists. METHODS: This was a retrospective cohort study from July 2017 to July 2018 in São Paulo, Brazil. We included 6633 individuals aged 60 years and older who presented with 12,770 skin lesions. Teledermatologists had three options to refer patients: (1) to undergo biopsy directly, (2) to an in-person dermatologist visit, and (3) back to the primary care physician with the most probable diagnosis and treatment. RESULTS: Teledermatology managed 66.66% (8408/12614) of dermatoses with the primary care physician without the need for an in-presence visit; 27.10% (3419/12614) were referred to dermatologists, and 6.24% (787/12614) directly to biopsy. The most frequent diseases were seborrheic keratosis, solar lentigo, onychomycosis, melanocytic nevus, benign neoplasms, actinic keratosis, epidermoid cyst, xerosis, leucoderma, and wart, with significant differences between sexes. Malignant tumors increased with age and were the leading cause for biopsies, while infectious skin conditions and pigmentary disorders decreased. Emollient was the most frequent treatment prescribed, in 31.88% (909/2856) of the cases. CONCLUSIONS: Teledermatology helped to treat 67% of the dermatoses of older individuals, addressing cases of minor complexity quickly and conveniently together with the primary care physician, thus optimizing dermatological appointments for the most severe, surgical, or complex diseases. Teledermatology does not aim to replace a face-to-face visit with the dermatologist; however, it might help to democratize dermatological treatment access for patients and decrease health care expenses.

[Chronic diseases in the paediatric population: Comorbidities and use of primary care services]. / Enfermedades crónicas en población pediátrica: comorbilidades y uso de servicios en atención primaria.

INTRODUCTION: Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG. PATIENTS AND METHODS: A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed. RESULTS: A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight. CONCLUSIONS: A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC.

Factors affecting the use of home-based services and out-of-home respite care services: A survey of family caregivers for older persons with dementia in Northern Norway.

BACKGROUND: Family caregivers contribute substantially to the care for older home-dwelling people with dementia, although community healthcare services tend to be underutilized. In this study, we aimed to explore the use and predictors of use of home-based and out-of-home respite care services available to older home-dwelling persons with dementia, as reported by the family caregivers. METHOD: A cross-sectional survey was administered to family caregivers (n = 430) in Northern Norway during April to November 2016. The use of healthcare services was categorized into two types according to principal component analysis: home-based services and out-of-home respite care services (R2 = 44.1%). Predictors of service use were examined with bivariate correlation, multiple linear regression, and Poisson regression analyses. RESULTS: The use of home-based services among persons with dementia was significantly higher for persons with advanced age, persons living in urban areas, persons living in an assisted living facility, persons living alone, and persons able to manage being alone for a short period of time. Among the family caregiver variables, higher age, status as a daughter, son, or other family member, higher educational level, and full-time employment also predicted greater use of home-based services. Same ethnicity was associated with use of fewer home-based services. The use of out-of-home respite care services was significantly higher among male persons with dementia and among those living in urban areas. In addition, fewer out-of-home respite care services were used by male caregivers or daughters of the care recipient, while the use was higher when the caregivers experienced more caregiving demands or had provided care for longer periods of time. CONCLUSIONS: These results indicate areas that policymakers and healthcare providers should consider to identify families who underutilize healthcare services and to achieve a more equal and efficient allocation of services in accordance with families' needs.

Explorando el papel de la autoeficacia parental en el uso de los servicios sanitarios: revisión de la literatura / xploring the relationship between parental self-efficacy and the use of health services: a literature review

INTRODUCCIÓN: El número de consultas de urgencias pediátricas en los últimos años han experimentado un aumento notable. Muchos son los factores que influyen en el uso de los servicios sanitarios y en el uso que los padres hacen de estos servicios. Se ha demostrado que la autoeficacia parental juega un papel fundamental en el manejo de la salud y la enfermedad de los niños, y puede que también lo esté haciendo en el uso de los servicios de salud. OBJETIVO: Se plantea esta revisión narrativa de la literatura, con el propósito de explorar el papel que la autoeficacia parental tiene en el cuidado de los niños y el uso de los servicios sanitarios. MÉTODO: Se realizó una búsqueda bibliográfica en Pubmed, Cinhal y Psyc-Info. RESULTADOS: No se encontraron estudios que explorasen de manera directa la autoeficacia parental y el uso de los servicios sanitarios. Sin embargo, la relación existente entre el concepto de autoeficacia y el manejo de la salud infantil y las enfermedades menores conduce a pensar que la autoeficacia parental puede estar jugando un papel importante en el uso de los servicios sanitarios. CONCLUSIÓN: Es necesario llevar a cabo estudios que ayuden a explorar la relación entre la autoeficacia parental y el uso de los servicios. Esta información puede ser de gran ayuda para planificar acciones de educación para la salud acordes con las necesidades de esta población y contribuir a la sostenibilidad del sistema, reduciendo las visitas innecesarias a los servicios de urgencias.

INTRODUCTION: The number of visits to emergency departments in recent years has increased significantly. There are many factors that influence the use of health services and the use that parents make of these services. It has been shown that parental self-efficacy plays a fundamental role in the management of children's health and illness and may also be the case in the use of health services. OBJECTIVE: The purpose of this narrative review was to explore the role that parental self-efficacy plays in the care of children and the use of health services. METHODS: To this end, a bibliographic search was carried out in Pubmed, Cinhal and PsycINFO. RESULTS: No studies were found that directly explored parental self-efficacy and the use of health services. However, the relationship between the concept of self-efficacy and the management of children's health and minor illnesses shown in the literature points out towards the idea that parental self-efficacy may be playing an important role in the use of health services. CONCLUSION: Future observational studies are necessary to explore the relationship between parental-self-efficacy and use of service. This information can be of great help in planning health education actions according to the needs of this population and contributing to the sustainability of the system, decreasing unnecessary visits to the emergency departments.

Factors associated with visits to general practitioners in patients with schizophrenia in Malaga.

BACKGROUND: Patients with psychiatric disorders have more physical problems than other patients, so their follow-up by the general practitioner is particularly important for them. METHODS: We aimed to elaborate a multilevel explanatory model of general practitioner (GP) visits made by patients with schizophrenia and related disorders (SRD). An observational, cross-sectional study was conducted from January 1, 2008 to July 1, 2011, in the area of the Clinical Management Unit of Mental Health (CMU-MH) of the Regional Hospital of Malaga (Spain). The eligible population consisted of all patients with SRD in contact with a GP residing in the study area. Our dependent variable was total number GP visits. The independent variables were: 1) patient variables (sociodemographic and clinical variables); 2) primary care centre (PCC) variables. We performed descriptive analysis, bivariate analysis and multilevel regression. RESULTS: Four hundred ninety four patients were included. Mean annual number of GP visits was 4.1. Female sex, living in a socioeconomically deprived area, a diagnosis of schizoaffective disorder and contact with a GP who had a more active approach to mental health issues were associated with a higher number of visits whilst being single and good communication between the PCC and mental health teams were associated with a lower number of GP visits. CONCLUSIONS: Number of GP visits was not just associated with patient factors, but also with organisational and the involvement of health professionals, for example GPs with an active approach to mental health issues.