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1.
J Med Econ ; 24(1): 328-338, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33576296

RESUMO

BACKGROUND: Non-small cell lung cancer (NSCLC) with brain metastases (BM) is difficult to treat and associated with poor survival. This study assessed the impact of BM on healthcare-related utilization and costs (HRUC) among patients receiving epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). PATIENTS AND METHODS: Adults newly-diagnosed with metastatic NSCLC, initiating first-/second-generation EGFR-TKI treatment, with BM or no BM (NBM), were identified retrospectively from IBM MarketScan healthcare claims databases (2013-2017). HRUC were measured during the variable-length follow-up period. Generalized linear models assessed the impact of BM on total healthcare costs, standardized to 2017 US$. RESULTS: Overall, 222 BM and 280 NBM patients were included, with a mean duration of follow-up of 14 months. Adjusted NSCLC-related and all-cause costs over average follow-up were 1.2 times higher among BM patients (Δ$5,640 and Δ$6,366, respectively; p <0.05); differences were driven primarily by radiation treatment and radiology. More than two times more BM than NBM patients received NSCLC-related radiation treatment, in both inpatient (15.3% vs 6.8%; p <0.05) and outpatient settings (87.8% vs 37.5%; p <0.05). Per-patient per-month (PPPM) radiation costs were also higher among BM patients, both inpatient ($796 vs $464, p =0.172) and outpatient ($2,443 vs $747, p <0.05). All-cause PPPM radiology visits (2.0 vs 1.3) and associated costs ($3,824 vs $1,621) were higher among BM patients (both p <0.05). CONCLUSION: NSCLC-related HRUC, especially those attributable to radiation treatment, were higher among patients with BM. Future research should compare the potential for CNS-active EGFR-TKIs vs first-/second-generation EGFR-TKIs combined with radiotherapy to reduce HRUC.


Assuntos
Neoplasias Encefálicas/economia , Neoplasias Encefálicas/secundário , Carcinoma Pulmonar de Células não Pequenas/patologia , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Neoplasias Pulmonares/patologia , Fatores Etários , Idoso , Antineoplásicos/uso terapêutico , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Receptores ErbB/antagonistas & inibidores , Gastos em Saúde/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Pessoa de Meia-Idade , Modelos Econômicos , Inibidores de Proteínas Quinases/uso terapêutico , Fatores Sexuais , Fatores Socioeconômicos
3.
Epidemiol Health ; 43: e2021007, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33445821

RESUMO

OBJECTIVES: This study explored socioeconomic disparities in Korea using health insurance type as a proxy during the ongoing coronavirus disease 2019 (COVID-19) pandemic. METHODS: We conducted a retrospective cohort study using Korea's nationwide healthcare database, which contained all individuals who received a diagnostic test for COVID-19 (n=232,390) as of May 15, 2020. We classified our cohort by health insurance type into beneficiaries of the National Health Insurance (NHI) or Medicaid programs. Our study outcomes were infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19-related outcomes, a composite of all-cause death, intensive care unit admission, and mechanical ventilation use. We estimated age-, sex-, and Charlson comorbidity index score-adjusted odds ratios (aORs) with 95% confidence intervals (CIs) using a multivariable logistic regression analysis. RESULTS: Of the 218,070 NHI and 14,320 Medicaid beneficiaries who received COVID-19 tests, 7,777 and 738 tested positive, respectively. The Medicaid beneficiaries were older (mean age, 57.5 vs. 47.8 years), more likely to be males (47.2 vs. 40.2%), and had a higher comorbidity burden (mean CCI, 2.0 vs. 1.7) than NHI beneficiaries. Compared to NHI beneficiaries, Medicaid beneficiaries had a 22% increased risk of SARS-CoV-2 infection (aOR, 1.22; 95% CI, 1.09 to 1.38), but had no significantly elevated risk of COVID-19-related outcomes (aOR 1.10, 95% CI 0.77 to 1.57); the individual events of the composite outcome yielded similar findings. CONCLUSIONS: As socioeconomic factors, with health insurance as a proxy, could serve as determinants during the current pandemic, pre-emptive support is needed for high-risk groups to slow its spread.


Assuntos
/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Seguro Saúde/estatística & dados numéricos , Pandemias , Adulto , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
4.
Med Care ; 59(1): 46-52, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33027238

RESUMO

BACKGROUND: As the population with human immunodeficiency virus (HIV) continues to age, the need for nursing home (NH) care is increasing. OBJECTIVES: To assess whether NH's experience in treating HIV is related to outcomes. RESEARCH DESIGN: We used claims and assessment data to identify individuals with and without HIV who were admitted to NHs in 9 high HIV prevalent states. We classified NHs into HIV experience categories and estimate the effects of NH HIV experience on patient's outcomes. We applied an instrumental variable using distances between each individual's residence and NHs with different HIV experience. SUBJECTS: In all, 5,929,376 admissions for those without HIV and 53,476 admissions for residents with HIV. MEASURES: Our primary outcomes were 30-day hospital readmissions, likelihood of becoming a long stay resident, and 180-day mortality posthospital discharge. RESULTS: Residents with HIV tended to have poorer outcomes than residents without HIV, regardless of the NH they were admitted to. Residents with HIV admitted to high HIV experience NHs were more likely to be readmitted to the hospital than those admitted to NHs with lower HIV experience (19.6% in 0% HIV NHs, 18.7% in 05% HIV NHs and 22.9% in 5%-50% HIV NHs). CONCLUSIONS: Residents with HIV experience worse outcomes in NHs than residents without HIV. Increased HIV experience was not related to improved outcomes.


Assuntos
Infecções por HIV/enfermagem , Revisão da Utilização de Seguros/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Idoso , Feminino , Infecções por HIV/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos
5.
Med Care ; 59(1): 38-45, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33165147

RESUMO

BACKGROUND: Higher risk-adjusted rate of emergency department (ED) visits might reflect poor quality of nursing home (NH) care; however, existing evidence is limited regarding rural-urban differences in ED rates of NHs, especially for long-stay residents. OBJECTIVES: To determine and quantify sources of rural-urban differences in NH risk-adjusted rates of any ED visit, ED without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED) of long-stay residents. RESEARCH DESIGN: We calculated quarterly NH risk-adjusted rates using 2011-2013 national Medicare claims and Minimum Data Set 3.0, and then implemented Generalized Estimating Equation models to examine rural-urban differences in ED rates and Blinder-Oaxaca decomposition to quantify the contributions of NH and market factors. SUBJECTS: Privately owned, free-standing NHs in the United States (N=13,260). RESULTS: Over the study period, risk-adjusted rates averaged 9.8% for any ED, 3.3% for outpatient ED, and 3.2% for PAED. Compared with urban NHs, rural NHs were associated with significantly lower rates of any ED, outpatient ED, and PAED (ß=-1.67%, -0.44%, and -0.28%; all P<0.01). Observable differences in market factors (nursing home bed concentration, hospital beds, and the existence of a critical access hospital) explained about half of the rural-urban differences in rates of any ED and PAED, but not outpatient ED. CONCLUSIONS: Decomposition analyses suggested that lower ED rates in rural NHs appear to be related to market availability of hospital resources. Policymakers may focus on not only reducing unnecessary ED visits but also ensuring equitable hospital access in rural areas.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Modelos Estatísticos , Casas de Saúde/estatística & dados numéricos , Risco Ajustado , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Sobremedicalização/estatística & dados numéricos , Medicare , Estados Unidos
6.
Diabetes Res Clin Pract ; 172: 108641, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33359573

RESUMO

AIMS: There is sufficient scientific evidence for the bidirectional association between periodontal diseases and diabetes. In this context, we hypothesized that periodontal treatment leads to lower healthcare costs in newly diagnosed diabetes patients by promoting a milder disease course. METHODS: A total of 23,771 persons were investigated who were continuously insured by German health insurances between 2011 and 2016, 18 years or older, and newly diagnosed with diabetes in 2013. The study population was divided into a periodontal treatment and control group (no periodontal treatment). The average treatment effect of a periodontal treatment on various types of healthcare costs (inpatient, outpatient, drug costs) was analyzed by a doubly robust method. RESULTS: Finally, 5.3% of the study population could be assigned to the treatment group. In newly diagnosed diabetes patients with periodontal treatment, a reduction in total healthcare costs (0.96, 95%CI 0.89; 1.04), inpatient costs (0.87, 95%CI 0.69; 1.08), diabetes-related drug costs (0.93, 95%CI 0.84; 1.03) and other drug costs (0.97, 95%CI 0.89; 1.05) could be shown compared to the control group. CONCLUSIONS: This study provides evidence that periodontal treatment for diabetes patients reduces healthcare costs. Fewer diabetes-specific complications and hospitalizations are expected.


Assuntos
Bases de Dados Factuais/normas , Diabetes Mellitus Tipo 2/complicações , Custos de Cuidados de Saúde/estatística & dados numéricos , Doenças Periodontais/economia , Feminino , Alemanha , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Doenças Periodontais/terapia , Estudos Retrospectivos
7.
PLoS One ; 15(12): e0244521, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370390

RESUMO

PURPOSE: To counter the global health threat of antimicrobial resistance, effective antimicrobial stewardship programs are needed to improve antimicrobial use (AMU) among dentists in addition to physicians. This study aimed to investigate the nationwide epidemiology of AMU among Japanese dentists to facilitate the development of dentist-centered programs. METHODS: We conducted a retrospective population-based study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan to analyze the AMU among Japanese dentists between 2015 and 2017. AMU was quantified as the defined daily doses per 1,000 inhabitants per day (DID). The trends in dentist-prescribed AMU were examined according to antimicrobial category and administration route. We also compared outpatient oral AMU between dentists and physicians as well as between on-site and off-site dispensing. RESULTS: The DID values of dentist-prescribed AMU were 1.23 in 2015, 1.22 in 2016, and 1.21 in 2017. During this study period, outpatient oral antimicrobials comprised the majority (approximately 99%) of dentist-prescribed AMU, and cephalosporins were the most frequently prescribed antimicrobials (>60% of all antimicrobials). The DID values of outpatient oral AMU were 1.21 for dentists and 12.11 for physicians. The DID value for on-site dispensing was 0.89 in 2017, in which cephalosporins were the predominantly used antimicrobials (DID: 0.60). CONCLUSIONS: Interventions that target dentists in Japan should focus on on-site dispensing of oral antimicrobials (especially cephalosporins) for outpatients. Further studies are needed to ascertain the underlying factors of oral cephalosporin prescriptions to guide the development of effective antimicrobial stewardship programs.


Assuntos
Anti-Infecciosos/administração & dosagem , Cefalosporinas/administração & dosagem , Prescrições de Medicamentos/estatística & dados numéricos , Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , Cefalosporinas/uso terapêutico , Humanos , Revisão da Utilização de Seguros , Japão/epidemiologia , Pacientes Ambulatoriais , Padrões de Prática Odontológica , Padrões de Prática Médica , Estudos Retrospectivos , Inquéritos e Questionários
8.
Pediatr Dent ; 42(6): 457-463, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33369557

RESUMO

Purpose: A Current Dental Terminology (CDT) code, D1354, for silver diamine fluoride was made effective on January 1, 2016. The purpose of this study was to investigate the utilization of silver diamine fluoride (SDF) by pediatric dentists (PDs) and general dentists (GDs) in the United States. Methods: Data were obtained from a commercial dental insurance claims warehouse in the United States. Deidentified data for CDT code D1354 were collected from January 2016 to July 2019. Descriptive statistics and chi-square tests were used. Results: A total of 321,726 D1354 claims were found. Data showed that SDF use measured by average monthly claims, unique number of dentists, and percent of paid claims increased each year. Patients zero to nine years old were the most likely to receive SDF treatment. SDF was significantly more likely to be placed on posterior teeth and in children zero to eight years old (P<0.001). PDs were more likely than GDs to submit claims for SDF in children (P<0.001). Conclusions: Silver diamine fluoride use is increasing, especially in patients age zero to nine years. Pediatric dentists are more likely to use SDF in children than general dentists. Posterior teeth receive the majority of SDF treatment.


Assuntos
Cárie Dentária , Revisão da Utilização de Seguros , Cariostáticos , Criança , Pré-Escolar , Cárie Dentária/prevenção & controle , Odontólogos , Fluoretos Tópicos , Humanos , Lactente , Recém-Nascido , Compostos de Amônio Quaternário , Compostos de Prata , Estados Unidos
9.
Artigo em Inglês | MEDLINE | ID: mdl-33316981

RESUMO

Non-response in surveys can lead to bias, which is often difficult to investigate. The aim of this analysis was to compare factors available from claims data associated with survey non-response and to compare them among two samples. A stratified sample of 4471 persons with a diagnosis of axial spondyloarthritis (axSpA) and a sample of 8995 persons with an osteoarthritis (OA) diagnosis from a German statutory health insurance were randomly selected and sent a postal survey. The association of age, sex, medical prescriptions, specialist physician contact, influenza vaccination, hospitalization, and Elixhauser comorbidity index with the survey response was assessed. Multiple logistic regression models were used with response as the outcome. A total of 47% of the axSpA sample and 40% of the OA sample responded to the survey. In both samples, the response was highest in the 70-79-year-olds. Women in all age groups responded more often, except for the 70-79-year-olds. Rheumatologist/orthopedist contact, physical therapy prescription, and influenza vaccination were more frequent among responders. In the logistic regression models, rheumatologist/orthopedist treatment, influenza vaccination, and physical therapy were associated with a higher odds ratio for response in both samples. The prescription of biologic drugs was associated with higher response in axSpA. A high Elixhauser comorbidity index and opioid use were not relevantly associated with response. Being reimbursed for long-term care was associated with lower response-this was only significant in the OA sample. The number of quarters with a diagnosis in the survey year was associated with higher response. Similar factors were associated with non-response in the two samples. The results can help other investigators to plan sample sizes of their surveys in similar settings.


Assuntos
Revisão da Utilização de Seguros , Osteoartrite , Espondilartrite , Inquéritos e Questionários , Idoso , Viés , Produtos Biológicos , Estudos Transversais , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Osteoartrite/tratamento farmacológico , Osteoartrite/epidemiologia , Espondilartrite/tratamento farmacológico , Espondilartrite/epidemiologia , Inquéritos e Questionários/estatística & dados numéricos
10.
JAMA Netw Open ; 3(12): e2030214, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33337495

RESUMO

Importance: Sexual and reproductive health services are a primary reason for care seeking by female young adults, but the association of the 2010 Patient Protection and Affordable Care Act Dependent Coverage Expansion (ACA-DCE) with insurance use for these services has not been studied to our knowledge. Insurer billing practices may compromise dependent confidentiality, potentially discouraging dependents from using insurance or obtaining care. Objective: To evaluate the association between implementation of ACA-DCE and insurance use for confidential sexual and reproductive health services by female young adults newly eligible for parental coverage. Design, Setting, and Participants: For this cross-sectional study, a difference-in-differences analysis of a US national sample of commercial claims from January 1, 2007, to December 31, 2009, and January 1, 2011, to December 31, 2016, captured insurance use before and after policy implementation among female young adults aged 23 to 25 years (treatment group) who were eligible for dependent coverage compared with those aged 27 to 29 years (comparison group) who were ineligible for dependent coverage. Data were analyzed from January 2019 to February 2020. Exposures: Eligibility for parental coverage under the ACA-DCE as of 2010. Main Outcomes and Measures: Probability of insurance use for contraception and Papanicolaou testing. Emergency department and well visits were included as control outcomes not sensitive to confidentiality concerns. Linear probability models adjusted for age, plan type, annual deductible, comorbidities, and state and year fixed effects, with SEs clustered at the state level. Results: The study sample included 4 690 699 individuals (7 268 372 person-years), with 2 898 275 in the treatment group (mean [SD] age, 23.7 [0.8] years) and 1 792 424 in the comparison group (mean [SD] age; 27.9 [0.8] years). Enrollees in the treatment group were less likely to have a comorbidity (77.3% vs 72.9%) and more likely to have a high deductible plan (14.6% vs 10.1%) than enrollees in the comparison group. Implementation of the ACA-DCE was associated with a -2.9 (95% CI, -3.4 to -2.4) percentage point relative reduction in insurance use for contraception and a -3.4 (95% CI, -3.9 to -3.0) percentage point relative reduction in Papanicolaou testing in the treatment vs comparison groups. Emergency department and well visits increased 0.4 (95% CI, 0.2-0.7) and 1.7 (95% CI, 1.3-2.1) percentage points, respectively. Conclusions and Relevance: The findings suggest that implementation of the ACA-DCE was associated with a reduction in insurance use for sexual and reproductive health services and an increase in emergency department and well health visits by female young adults newly eligible for parental coverage. Some young people who gained coverage under the expansion may not be using essential, confidential services.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde , Serviços de Saúde Reprodutiva , Saúde Sexual , Serviços de Saúde da Mulher , Anticoncepção/estatística & dados numéricos , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/organização & administração , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act , Serviços de Saúde Reprodutiva/economia , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Saúde Sexual/economia , Saúde Sexual/estatística & dados numéricos , Estados Unidos , Serviços de Saúde da Mulher/economia , Serviços de Saúde da Mulher/estatística & dados numéricos , Adulto Jovem
11.
J Nurs Adm ; 50(12): 642-648, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33186003

RESUMO

OBJECTIVE: The purpose of this study was to analyze if patient race and the presence of insurance predict the odds of admission from the emergency department (ED) for patients diagnosed with congestive heart failure (CHF). BACKGROUND: Excessive hospital readmissions for patients with CHF are considered a quality-of-care issue. Previous studies have not considered race and insurance in conjunction with quality measures in predicting hospital admission from the ED for these patients. METHODS: A secondary data analysis was conducted from cross-sectional archival data from the 2015 National Hospital Ambulatory Medical Care Survey using cross-tabulations with χ followed by multiple logistic regression analysis. RESULTS: Race and the presence of insurance were not significant in predicting the odds of admission from the ED for patients with CHF. CONCLUSIONS: Being seen in the ED within the last 72 hours and seen by provider types consulting physician and nurse practitioner were significant (P ≤ .05) in predicting the odds of admission related to a diagnosis of CHF.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Revisão da Utilização de Seguros/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Medicare , Alta do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos
12.
Australas Psychiatry ; 28(6): 639-643, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33016772

RESUMO

OBJECTIVE: To analyse the smaller Australian state/territory service impact of the introduction of new COVID-19 psychiatrist video and telephone telehealth Medicare Benefits Schedule (MBS) items. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video and telephone telehealth item numbers corresponding to the pre-existing in-person consultations for the Australian Capital Territory (ACT), Northern Territory (NT), South Australia (SA) and Tasmania. RESULTS: The overall rate of consultations (face-to-face and telehealth) increased during March and April 2020, compared to the monthly face-to-face consultation average, excepting Tasmania. Compared to an annual monthly average of in-person consultations for July 2018-June 2019, total telepsychiatry consultations were higher for April than May. For total video and telephone telehealth consultations combined, video consultations were lower in April and higher in May. As a percentage of combined telehealth and in-person consultations, telehealth was greater for April and lower for May compared to the monthly face-to-face consultation average. CONCLUSIONS: In the smaller states/territories, the private practice workforce rapidly adopted COVID-19 MBS telehealth items, with the majority of psychiatric consultation shifting to telehealth initially, and then returning to face-to-face. With a second wave of COVID-19 in Australia, telehealth is likely to remain a vital part of the national mental health strategy.


Assuntos
Infecções por Coronavirus , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Padrões de Prática Médica , Prática Privada , Consulta Remota/métodos , Comunicação por Videoconferência , Adulto , Austrália/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Inovação Organizacional , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Padrões de Prática Médica/organização & administração , Padrões de Prática Médica/tendências , Prática Privada/organização & administração , Prática Privada/tendências , Telemedicina/métodos
13.
Australas Psychiatry ; 28(6): 644-648, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32997521

RESUMO

OBJECTIVE: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April-May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. METHOD: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018-2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. RESULTS: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%-20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15-30 min. Video consultations increased from April into May. CONCLUSIONS: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April-May 2020.


Assuntos
Infecções por Coronavirus , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Prática Privada , Consulta Remota/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Adulto , Austrália/epidemiologia , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/estatística & dados numéricos , Inovação Organizacional , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Prática Privada/organização & administração , Prática Privada/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração
14.
PLoS One ; 15(9): e0238930, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32941491

RESUMO

BACKGROUND: There are currently no tools for assessing claimants' perceived fairness in work disability evaluations. In our study, we describe the development and validation of a questionnaire for this purpose. METHOD: In cooperation with subject-matter experts of Swiss insurance medicine, we developed the 30-item Basel Fairness Questionnaire (BFQ). Claimants anonymously answered the questionnaire immediately after their disability evaluation, still unaware about its outcome. For each item, there were four response options, ranging from "strongly disagree" to "strongly agree". The construct validity of the BFQ was assessed by running a principal component analysis (PCA). RESULTS: In 4% of the questionnaires, the claimants' perception on the disability evaluation was negative (below the median of the scale). The PCA of the items responses followed by an orthogonal rotation revealed four factors, namely (1) Interviewing Skills, (2) Rapport, (3) Transparency, and (4) Case Familiarity, explaining 63.5% of the total variance. DISCUSSION: The ratings presumably have some positive bias by sample selection and response bias. The PCA factors corresponded to dimensions that subject-matter experts had beforehand identified as relevant. However, all item ratings were highly intercorrelated, which suggests that the presumed underlying dimensions are not independent. CONCLUSION: The BFQ represents the first self-administered instrument for measuring claimants' perceived fairness of work disability evaluations, allowing the assessment of informational, procedural, and interactive justice from the perspective of claimants. In cooperation with Swiss assessment centres, we plan to implement a refined version of the BFQ as feedback instrument in work disability evaluations.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/psicologia , Adulto , Viés , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Suíça
15.
PLoS One ; 15(9): e0238285, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925928

RESUMO

BACKGROUND: Chronic and high dose opioid use may result in adverse events. We analyzed the risk associated with chronic and high dose opioid prescription in a Swiss population. METHODS: Using insurance claims data covering one-sixth of the Swiss population, we analyzed recurrent opioid prescriptions (≥2 opioid claims with at least 1 strong opioid claim) between 2006 and 2014. We calculated the cumulative dose in milligrams morphine equivalents (MED) and treatment duration. Excluded were single opioid claims, opioid use that was cancer treatment related, and opioid use in substitution programs. We assessed the association between the duration of opioid use, prescribed opioid dose, and benzodiazepine use with emergency department (ED) visits, urogenital and pulmonary infections, acute care hospitalization, and death at the end of the episode. RESULTS: In 63,642 recurrent opioid prescription episodes (acute 38%, subacute 7%, chronic 25.8%, very chronic (>360 days) episodes 29%) 18,336 ED visits, 30,209 infections, 19,375 hospitalizations, and 9,662 deaths occurred. The maximum daily MED dose was <20 mg in 15.8%, 20-<50 mg in 16.6%, 50-<100 mg in 21.6%, and ≥100 mg in 46%. Compared to acute episodes (<90 days), episode duration was an independent predictor of ED visits (chronic OR 1.09 (95% CI 1.03-1.15), very chronic (>360 days) OR 1.76 (1.67-1.86)) for adverse effects; infections (chronic OR 1.74 (1.66-1.82), very chronic 4.16 (3.95-4.37)), and hospitalization (chronic: OR 1.22 (1.16-1.29), very chronic OR 1.82 (1.73-1.93)). The risk of death decreased over time (very chronic OR 0.46 (0.43-0.50)). A dose dependent increased risk was observed for ED visits, hospitalization, and death (≥100mg daily MED OR 1.21 (1.13-1.29), OR 1.29 (1.21-1.38), and OR 1.67, 1.50-1.85, respectively). A concomitant use of benzodiazepines increased the odds for ED visits by 46% (OR 1.46, 1.41-1.52), infections by 44% (OR 1.44, 1.41-1.52), hospitalization by 12% (OR 1.12, 1.07-1.1), and death by 45% (OR 1.45, 1.37-1.53). CONCLUSION: The length of opioid use and higher prescribed morphine equivalent dose were independently associated with an increased risk for ED visits and hospitalizations. The risk for infections, ED visits, hospitalizations, and death also increased with concomitant benzodiazepine use.


Assuntos
Analgésicos Opioides/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Hospitalização/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Transtornos Relacionados ao Uso de Opioides/etiologia , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/patologia , Prognóstico , Fatores de Risco
16.
PLoS One ; 15(9): e0238843, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915863

RESUMO

OBJECTIVE: The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS: Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS: 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION: Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.


Assuntos
Antidepressivos/economia , Assistência à Saúde/estatística & dados numéricos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Custos de Cuidados de Saúde , Recursos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Antidepressivos/uso terapêutico , Bases de Dados Factuais , Assistência à Saúde/economia , Transtorno Depressivo Maior/economia , Transtorno Depressivo Maior/epidemiologia , Transtorno Depressivo Resistente a Tratamento/economia , Transtorno Depressivo Resistente a Tratamento/epidemiologia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
17.
PLoS One ; 15(8): e0238000, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866182

RESUMO

The standard GLM and GAM frequency-severity models assume independence between the claim frequency and severity. To overcome restrictions of linear or additive forms and to relax the independence assumption, we develop a data-driven dependent frequency-severity model, where we combine a stochastic gradient boosting algorithm and a profile likelihood approach to estimate parameters for both of the claim frequency and average claim severity distributions, and where we introduce the dependence between the claim frequency and severity by treating the claim frequency as a predictor in the regression model for the average claim severity. The model can flexibly capture the nonlinear relation between the claim frequency (severity) and predictors and complex interactions among predictors and can fully capture the nonlinear dependence between the claim frequency and severity. A simulation study shows excellent prediction performance of our model. Then, we demonstrate the application of our model with a French auto insurance claim data. The results show that our model is superior to other state-of-the-art models.


Assuntos
Revisão da Utilização de Seguros/estatística & dados numéricos , Modelos Estatísticos , Processos Estocásticos
18.
PLoS One ; 15(8): e0237617, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32804969

RESUMO

Some findings on the association between glaucoma and statins in the Asian population have been reported. We conducted a retrospective cohort study using health insurance claims data maintained by the JMDC Inc., which comprises data on about three million individuals representing 2.4% of the Japanese population. The association between the potency of statins and open-angle glaucoma in Japanese working-age population was examined using a commercially available health insurance claims and enrollment database. We identified 117,036 patients with a prescription of statins between January 1, 2005 and March 31, 2014; 59,535 patients were selected as new statin users. Of these, 49,671 (83%) patients without glaucoma who were prescribed statins for the first time were part of the primary analysis. New users of statin were defined as those with a prescription of statin at the beginning of the study, but without a prescription six months earlier. The cohort comprised 29,435 (59%) and 20,236 (41%) patients with a prescription of high-potency statin (atorvastatin and rosuvastatin) and low-potency statin (pravastatin, fluvastatin, pitavastatin, and simvastatin), respectively. Using Cox proportional hazards regression analysis, hazard ratios (HRs) were estimated for glaucoma adjusted for baseline characteristics. Although some baseline characteristics were not similar between the high-potency and low-potency statin groups, the standardized difference for all covariates was less than 0.1. No associations were found between high-potency statin use and glaucoma (adjusted HR = 1.08; 95% confidence interval, 0.93-1.24) in the primary analyses, using the risk for glaucoma in the low-potency statin group as reference. The risk of glaucoma with individual statin use was not significantly different from that with pravastatin. No significant association was found between high-potency statins and the increased risk of glaucoma in Japanese working-age population. Further studies are needed to examine the association between statins and glaucoma in the elderly population.


Assuntos
Glaucoma de Ângulo Aberto/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/classificação , Adulto , Idoso , Feminino , Glaucoma de Ângulo Aberto/induzido quimicamente , Humanos , Revisão da Utilização de Seguros , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto Jovem
19.
Med Care ; 58(9): 800-804, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826745

RESUMO

OBJECTIVE: The objective of this study was to evaluate if the networks of diabetic patients sharing physicians are associated with emergency department (ED) visits and hospitalizations. STUDY DESIGN: This is a retrospective cohort study. METHODS: We used administrative data from a large insurer in Hawaii in 2010. Three types of networks were defined based on patient visits: (1) the total number of links from one patient to other patients sharing a physician; (2) the number of other patients connected by sharing the physician seen the most often; and (3) the number of other patients connected by seeing all the same physicians during the year. The networks were characterized into thirds based on their complexity and analyzed using zero-inflated negative binomial regression models on ED visits and hospitalizations. RESULTS: The study included 38,767 diabetes patients with a mean age of 64 years. Patients sharing the most physicians had double the risks of ED visits and hospitalizations. Patients linked by belonging to the largest primary care practices had a 28% reduced odds of ED visits. Patients linked by seeing all of the same physicians during the year had the fewest primary care providers and specialists visits and 25%-50% reductions in ED visits and hospitalizations. CONCLUSIONS: Networks of diabetic patients sharing all the same physicians were associated with decreased ED visits and hospitalizations. Encouraging diabetic patients to find a provider they like and trust and to stay in the provider's care may help reduce the risks of adverse events. Physicians building loyalty among their patients may reduce their patients' risks.


Assuntos
Redes Comunitárias , Diabetes Mellitus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Comorbidade , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros , Masculino , Pessoa de Meia-Idade , Características de Residência , Estudos Retrospectivos , Fatores Socioeconômicos , Adulto Jovem
20.
PLoS One ; 15(8): e0237082, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776954

RESUMO

To understand the cost burden of medical care it is essential to partition medical spending into conditions. Two broad strategies have been used to measure disease-specific spending. The first attributes each medical claim to the condition that physicians list as its cause. The second decomposes total spending for a person over a year to their cumulative set of health conditions. Traditionally, this has been done through regression analysis. This paper has two contributions. First, we develop a new cost attribution method to attribute spending to conditions using a more flexible attribution approach, based on propensity score analysis. Second, we compare the propensity score approach to the claims-based approach and the regression approach in a common set of beneficiaries age 65 and older in the 2009 Medicare Current Beneficiary Survey. Our estimates show that the three methods have important differences in spending allocation and that the propensity score model likely offers the best theoretical and empirical combination.


Assuntos
Efeitos Psicossociais da Doença , Custos e Análise de Custo/métodos , Idoso , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicare/estatística & dados numéricos , Pontuação de Propensão , Análise de Regressão , Estados Unidos
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