Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization

Purpose Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. Design Cross-sectional telephone survey. Setting All United States and Territories. Subjects 246 801 adults aged 18–64. Measures The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. Analysis Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. Results The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25–35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. Conclusion Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

Impact of the Covid-19 pandemic on primary care utilization: evidence from Sweden using national register data

Objective To analyze changes in primary care utilization as a result of the Covid-19 pandemic. Swedish national register data from 2019 to 2020 on utilization of services were used to compare overall utilization levels and across types of contacts and patient groups. A specific objective was to assess the extent to which remote types of patient consultations were able to compensate for any observed fall in on-site visits. Data were stratified by sex and age to investigate any demographic pattern. Results Findings show significant reductions in overall utilization of services as the pandemic occurred in the first quarter of 2020. On-site visits fell during the first wave of the pandemic and rebounded thereafter. Patients over 65 years of age appear to have reduced utilization to a larger extent compared with younger groups. Simultaneously, remote contacts increased from around 12% before the pandemic to 17% of the total number of consultations. However, the net effect of changes in service utilization suggests an overall reduction of around 12 percent in the number of primary care consultations as a result of the pandemic. No differences between men and women were observed. Further research will continue to monitor changes in primary care utilization as the pandemic continues.

Impact of the Covid-19 Pandemic on Primary Care Utilization: Evidence From Sweden Using National Register Data

Objective: To analyze changes in primary care utilization as a result of the Covid-19 pandemic. Swedish national register data from 2019 and 2020 on utilization of services were used to compare overall utilization levels and across types of contacts and patient groups. A specific objective was to assess the extent to which remote types of patient consultations were able to compensate for any observed fall in on-site visits. Data were stratified by sex and age to investigate any demographic pattern. Results: Findings show significant reductions in overall utilization of services as the pandemic occurred the first quarter of 2020. On-site visits fell during the first wave of the pandemic and rebounded thereafter. Patients over 65 years of age appear to have reduced utilization to a larger extent compared with younger groups. Simultaneously, remote contacts increased from around 12% before the pandemic to 17% of total number of consultations. However, the net effect of changes in service utilization suggests an overall reduction of around 12 percent in the number of primary care consultations as a result of the pandemic. No differences between men and women were observed. Further research will continue to monitor changes in primary care utilization as the pandemic continues.

Acute, Post-acute, and Primary Care Utilization in a Home-Based Primary Care Program During COVID-19

Background and Objectives Older adults with multiple comorbidities experience high rates of hospitalization and poor outcomes from Coronavirus Disease 2019 (COVID-19). Changes in care utilization by persons in advanced illness management (AIM) programs during the COVID-19 pandemic are not well known. The purpose of this study was to describe changes in care utilization by homebound AIM patients in an epicenter of the COVID-19 pandemic before and during the pandemic. Research Design and Methods Descriptive statistics and tests of differences were used to compare care utilization rates, including emergency department (ED) and inpatient admissions, acute and subacute rehabilitation, and AIM program utilization during the pandemic with rates 1 year prior. Results Acute and post-acute utilization for enrollees (n = 1,468) decreased March–May 2020 compared to 1 year prior (n = 1,452), while utilization of AIM program resources remained high. Comparing 2019 and 2020, ED visits/1,000 enrollees were 109 versus 44 (p < .001), inpatient admissions 213 versus 113 (p < .001), and rehabilitation facility admissions 56 versus 31 (p = .014); AIM program home visits were 1,935 versus 276 (p < .001), remote visits (telehealth/telephonic) 0 versus 1,079 (p < .001), and all other phone touches 3,032 versus 5,062 (p < .001). Home hospice admissions/1,000 increased: 16–31 (p = .011). Discussion and Implications Our results demonstrate decreased acute and post-acute utilization, while maintaining high levels of connectedness to the AIM program, among a cohort of homebound older adults during the COVID-19 pandemic compared with 1 year prior. While further study is needed, our results suggest that AIM programs can provide support to this population in the home setting during a pandemic.