Factors Associated with the Patient’s Decision to Avoid Healthcare during the COVID-19 Pandemic

The COVID-19 pandemic has resulted in changes in healthcare use. This study aimed to identify factors associated with a patient’s decision to avoid and/or delay healthcare during the COVID-19 pandemic. We used data from a community-based survey in Portugal from July 2020 to August 2021, “COVID-19 Barometer: Social Opinion”, which included data regarding health services use, risk perception and confidence in health services. We framed our analysis under Andersen’s Behavioural Model of Health Services Use and utilised Poisson regression to identify healthcare avoidance associated factors. Healthcare avoidance was high (44%). Higher prevalence of healthcare avoidance was found among women; participants who reported lower confidence in the healthcare system response to COVID-19 and non-COVID-19; lost income during the pandemic; experienced negative emotions due to physical distancing measures; answered the questionnaire before middle June 2021; and perceived having worse health, the measures implemented by the Government as inadequate, the information conveyed as unclear and confusing, a higher risk of getting COVID-19, a higher risk of complications and a higher risk of getting infected in a health institution. It is crucial to reassure the population that health services are safe. Health services should plan their recovery since delays in healthcare delivery can lead to increased or worsening morbidity, yielding economic and societal costs.

Family-Rated Pediatric Health Status Is Associated With Unplanned Health Services Use

OBJECTIVE: Self-rated health is a common self-reported health measure associated with morbidity, mortality, and health care use. The objective was to investigate the association of family-rated health status (FRH) in pediatric care with administrative indicators, patient and respondent features, and unplanned health services use. PATIENTS AND METHODS: Data were taken from Child-Hospital Consumer Assessment of Healthcare Providers and Systems surveys collected between 2015 and 2019 in Alberta, Canada and linked with administrative health records. Three analyses were performed: correlation to assess association between administrative indicators of health status and FRH, logistic regression to assess respondent and patient characteristics associated with FRH, and automated logistic regression to assess the association between FRH and unplanned health services use within 90 days of discharge. RESULTS: A total of 6236 linked surveys were analyzed. FRH had small but significant associations with administrative indicators. Models of FRH had better fit with patient and respondent features. Respondent relationship to child, child age, previous hospitalizations, and number of comorbidities were significantly associated with ratings of FRH. Automated models of unplanned services use included FRH as a feature, and poor ratings of health were associated with increased odds of emergency department visits (adjusted odds ratio: 2.15, 95% confidence interval: 1.62–2.85) and readmission (adjusted odds ratio: 2.48, 95% confidence interval: 1.62–2.85). CONCLUSION: FRH is a simple, single-item global rating of health for pediatric populations that provides accessible and useful information about pediatric health care needs. The results of this article serve as a reminder that family members are valuable sources of information that can improve care and potentially prevent unplanned health services use.

Use of Tangible, Educational, and Psychological Supportive Services Among Chinese American Dementia Caregivers

Background and Objectives Though many studies have examined the service utilization of dementia caregivers, there is limited empirical evidence from Asian Americans and the lack of incorporating community resources and sociocultural factors in this field. Guided by the Andersen's Behavioral Model of Health Services Use (ABM), we aimed to understand whether and how predisposing, enabling and need factors were associated with utilizing multiple types of services among Chinese Americans dementia caregivers. Research Design and Methods We collected survey data from 134 Chinese dementia caregivers in New York City. Logistic regression models were conducted to test the associations between predisposing, enabling and need factors and the likelihoods of using tangible (home health aide, adult daycare, respite care), educational (lectures and workshops), and psychological (peer support groups and psychological counseling) services. Results Consistent with prior literature, caregiver’s knowledge about services, caring tasks, length of care and burden and care recipient’s physical and cognitive deteriorations, were significantly associated with higher possibilities of using multiple types of services among these Chinese American dementia caregivers. Three sociocultural factors, including residing in Chinatowns, availability of alternative family caregivers and diagnosis of cognitive deterioration, were also associated with higher likelihoods of using educational or psychological services. Discussion and Implications: The findings extended the existing literature on service utilization of caregivers by highlighting the importance of distinguishing types of services and the necessity of considering sociocultural factors in future research and practice.

Retrospective cohort study of outpatient mental health visits in children and youth in Canadian military families

LAY SUMMARY This study tried to answer the question “Do children and youth in military families have a greater risk of emotional and behavioural problems than children and youth in the general population?” The authors used routinely collected health data from children and youth in Canadian Armed Forces families who relocated to Ontario, matched to data from children and youth in non-military families. They compared outpatient mental health services use, such as physician visits, and the reasons for those visits, such as depression. They found that children and youth in military families were more likely to visit a physician for specific mental health diagnoses than children and youth in the general population. More programming and resources supporting the mental health and well-being of children and youth in military families may be needed.

Using Andersen’s Behavioural Model of Health Services use to Examine usage of Intermittent Preventive Treatment of Malaria in Pregnancy in Nigeria

Background: Studies in Nigeria and elsewhere in sub-Saharan Africa have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). However, most of the studies are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting the Andersen’s behavioural model of health services use to IPTp usage in Nigeria.Methods: This study adopted a cross-sectional design that utilised secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had deliveries in the past year preceding the survey was analysed. The outcome variable was usage of IPTp dichotomised into optimal or otherwise. The explanatory variables cut across individual and community levels, and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify the factors influencing optimal usage of IPTp. Analyses were performed using Stata 14. Statistical significance was set at 5%. Results: The realised level of optimal IPTp usage was 21.8%. The factors that either predispose or enables a pregnant woman to take optimal doses of IPTp are age, education, being employed, being autonomous on own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facility, rural residence, being resident in northern geo-political zones, community literacy level, and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp are timing of first antenatal care contact and actual sleeping under mosquito bed net. Conclusion: Optimal usage of IPTp is low among pregnant women in Nigeria. There is need to devise additional public health education programme promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) core group in every ward in all the local government areas in the country. In addition, health planners in the country should adopt the use of the Andersen model for assessing key determinants of IPTp usage among childbearing women in the country.

Characterization of Medical Conditions of Children with Sickle Cell Disease in the United States: Findings from the 2007-2018 National Health Interview Surveys (NHIS)

Background: Sickle cell disease (SCD), one of the most common genetic disorders in the United States (US), affects 70,000 to 100,000 children. The burden is greatest among the African American population, where SCD impacts 1 in 365 live births. Children with SCD have been observed to have lower Health-Related Quality of life (HRQoL) due to the impact of severe disease-related complications and comorbidities, including infections, pain crises, acute chest syndrome, metabolic alterations and overt stroke. SCD and its related comorbidity and complications result in increased health care utilization, particularly emergency department use- which accounts for 80% of medical expenditure. Further, studies using US population-based data to characterize the health status and health care utilization for SCD children is lacking. With the exception of a study conducted by Boulet et al. in 2010, which examined the 1997-2005 National Health Interview Surveys (NHIS) data to describe health status and health services use among Black children aged 0-17 years with SCD. To fill this important gap, we used the 2007-2018 NHIS data to describe health status and health services use among SCD children aged 0-17 years and conducted a sub-analysis for Black children to better characterize SCD- related medical conditions affecting this population and health care utilization patterns. Methods: The study included an unweighted sample of 133,542 children, with 68,745 male children and 64,797 female children. Questionnaires were answered by a parent/guardian on behalf of the child. We examined (1) the prevalence of medical comorbidities; (2) indicators of functional status and perceived health status; (3) use of healthcare services; (4) barriers to accessing healthcare services; and (5) association of the comorbidities with the utilization of care. We hypothesized that Black children with SCD would have higher levels of disease-related complications and comorbidities, as well as healthcare utilization than their counterparts without SCD. We used logistic regression to compare the associations between 'SCD' and 'No SCD' on various medical conditions for all races and for Black children only groups. Results: Of the 133,542 children, 215 have SCD (.16%). Among the SCD children, 51.1% are male, Black: 170 (79.1%), White: 16 (7.44%), American Indian: 1(.47%), Asian 2 (.93%): other races: 21 (9.77%) and Multiple Races 5 (2.33%). Black children had a higher prevalence of SCD than other races and Black children with SCD were more likely to have a household income < 1% of the federal poverty levels compared to those without. After applying the appropriate weights to each of the demographics, children of all races with SCD had higher adjusted odds (Adjusted Odds Ratio -AOR) of having anemia (AOR 37.6; CI: 22.3, 63.3: p=0.000), respiratory allergies (AOR 2.2; CI: 1.3, 3.8; p=0.005), food/digestive allergies (AOR 2.1; CI: 1.0, 4.1: p=0.042), eczema/skin allergies (AOR 2.1; CI: 1.3, 3.6: p=0.004), and frequent severe headaches/migraines (AOR 2.2; CI: 1.1, 4.3; p=0.024). Children with SCD are also more likely to experience frequent diarrhea/colitis, although statistically non-significant. Among Black children, those with SCD had higher odds of having the following medical conditions including anemia (AOR 18.7; CI: 10.7,32.3: p=0.000), and respiratory allergies (AOR 2.4; CI: 1.3, 4.4: p=0.004) and also more likely to experience other conditions including food/digestive allergies, eczema/skin allergies, and frequent severe headaches/migraines, although statistically non-significant (p>0.5). Children of all races (26.0%) and Black children (28.8%) with SCD had at least 2 or more annual emergency room visits (p=0.000). Conclusion: Our study findings indicate that children with SCD for all races experienced significant comorbid conditions associated with disease status. Moreover, among Black children, those with SCD have increased SCD related comorbidity, worse health status, and an increased number of visits to the emergency room compared to children without SCD. This creates the urgency to address the health burden for Black children with SCD, by identifying 'beneficial' health care utilization services (non-emergency services) that improves the quality of life for SCD children. Future research should address residual gaps in information about health burden and healthcare utilization among SCD population in the US. Disclosures No relevant conflicts of interest to declare.

Prevalence of and factors associated with receipt of provider recommendation for influenza vaccination and uptake of influenza vaccination during pregnancy: cross-sectional study

Background Seasonal influenza vaccination has been recommended for pregnant women in Germany since 2010. The aim of this study was to examine prevalence and determinants of receipt of provider recommendation for influenza vaccination as well as influenza vaccination uptake during pregnancy. Methods We analysed data from the “KUNO Kids Health Study”, a prospective birth cohort. During the study period (5th July 2015 to 27th June 2018) data were collected from participating mothers by interview and questionnaire. According to Andersen’s behavioural model of health services use potential influencing factors describing the circumstances and characteristics of the mothers and their pregnancies which are potentially affecting whether women receive a recommendation for a vaccination or whether they utilize influenza vaccination were classified into three domains: ‘predisposing characteristics’, ‘enabling resources’ and ‘need’. Using multivariable logistic regression models odds ratios (OR) and corresponding 95% confidence intervals (95% CI) were calculated. Results As a combined result across three flu seasons, 368 of 1814 (20.3%) women received an influenza vaccination recommendation during pregnancy. Having had a high-risk pregnancy increased the odds of receiving a vaccination recommendation (OR = 1.3; 95% CI = 1.0–1.6; p = 0.045). In contrast, pregnancy onset in summer (OR = 0.7; 95% CI = 0.5–1.0; p = 0.027), autumn (OR = 0.4; 95% CI = 0.3–0.5; p < =0.001) or winter (OR = 0.5; 95% CI = 0.3–0.6; p < =0.001) (compared to spring) as well as mother’s birthplace outside Germany (OR = 0.6; 95% CI = 0.4–0.9; p = 0.023) reduced the chance of getting a vaccination recommendation. Two hundred forty-two of one thousand eight hundred sixty-five (13%) women were vaccinated against influenza during pregnancy. Having received a vaccination recommendation was strongly associated with vaccination uptake (OR = 37.8; 95% CI = 25.5–55.9; p < =0.001). Higher health literacy status was also associated with a higher chance of vaccination uptake (OR = 1.7; 95% CI = 1.2–2.6; p = 0.008), whereas pregnancy onset in autumn (compared to spring) reduced the chance (OR = 0.5; 95% CI = 0.3–0.8; p = 0.008). Conclusions At 13% the uptake rate of influenza vaccination is low. Having received a recommendation to vaccinate was strongly associated with uptake but only one fifth of all mothers report such a recommendation. Raising awareness in physicians regarding vaccinating during pregnancy seems to be of essential importance to increase vaccine uptake and to prevent influenza-related complications in pregnant women.