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Health service utilization in immigrants with multiple sclerosis.

ABSTRACT: BACKGROUND:Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. OBJECTIVE:To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. METHODS:We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. RESULTS:From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94). CONCLUSIONS:Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation.

SUBMITTER: Rotstein DL

PROVIDER: S-EPMC7347150 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Health service utilization in immigrants with multiple sclerosis.

Rotstein Dalia L DL Marrie Ruth Ann RA Tu Karen K Schultz Susan E SE Fung Kinwah K Maxwell Colleen J CJ

PloS one 20200709 7

<h4>Background</h4>Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status.<h4>Objective</h4>To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada.<h4>Methods</h4>We identified incident cases of MS among adults aged 20-65 years by ...[more]

PMID: 32645017

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Project description:IntroductionMany studies have investigated pregnancy in women with multiple sclerosis (MS). However, no study has measured prenatal healthcare utilization in women with MS or adherence to follow-up recommendations to improve antenatal care quality. A better knowledge of the quality of antenatal care in women with MS would help identify and better support women with insufficient follow-up. Our objective was to measure the level of compliance to prenatal care recommendations in women with MS using data from the French National Health Insurance Database.MethodsThis retrospective cohort study included all pregnant women with MS who gave live birth in France between 2010 and 2015. Using the French National Health Insurance Database, follow-up visits with gynecologists, midwives, and general practitioners (GPs) were identified, as well as ultrasound exams and laboratory tests. Based on the Adequacy of Prenatal Care Use and Content and Timing of care in Pregnancy indices, a new tool adapted to the French recommendations was developed to measure and classify the antenatal care trajectory (adequate or inadequate). Explicative factors were identified using multivariate logistic regression models. A random effect was included because women may have had more than one pregnancy during the study period.ResultsIn total, 4,804 women with MS (N = 5,448 pregnancies ending in live births) were included. When considering only visits with gynecologists/midwives, 2,277 pregnancies (41.8%) were considered adequate. When adding visits with GP, their number increased to 3,646 (66.9%). Multivariate models showed that multiple pregnancy and higher medical density were associated with better adherence to follow-up recommendations. Conversely, adherence was lower in 25-29-year-old and >40-year-old women, in women with very low income, and agricultural and self-employed workers. No visits, ultrasound exams, and laboratory tests were recorded in 87 pregnancies (1.6%). In 50% of pregnancies, women had at least one visit with a neurologist during the pregnancy, and women restarted disease-modifying therapy (DMT) within 6 months after delivery in 45.9% of pregnancies.DiscussionMany women consulted their GP during pregnancy. This could be linked to a low density of gynecologists but may also reflect the preferences of women. Our findings can help adapt recommendations and healthcare providers' practices according to the women's profiles.

Project description:BACKGROUND:The utilization of oral health services in children remains at a relatively low level in China. However, little is known about the utilization patterns and related factors. The objective of this study was to explore the patterns of oral health service utilization and to determine the related factors among preschool children in Beijing, China, based on the Andersen behavioral model. METHODS:A cross-sectional study of 1425 preschool children aged 2 to 6 years was carried out in five kindergartens in Beijing, China. A questionnaire investigation of parents/caregivers was performed to collect information on oral health service utilization. Oral health needs were evaluated through oral health examinations. Chi-square tests, t-tests, multivariate logistic regression and negative binomial regression were used in this study to identify the variables associated with oral health service utilization. RESULTS:In total, 648 (45.5%) children had utilized oral health services in the past 12 months, while 24.3% had utilized preventive oral health services. Routine checkups and receiving preventive measures accounted for 63.2% of the children who utilized oral health services in the past 12 months. Children were more likely to have utilized oral health services in the past 12 months if they attended kindergartens with regular oral health care resources, if their oral health status as perceived by their parents/parents was "fair" or "poor", if they had more decayed, missing and filled teeth (dmft) and if they had experienced more dental pain. In addition, children with more dental pain and more access to oral health services, whose oral health status was perceived by parents/caregivers as worse tended to have utilized oral health services more frequently in the past 12 months. CONCLUSIONS:In conclusion, we found a strong association between access to regular oral health care resources and oral health service utilization among preschool children. Children whose oral health status was perceived by parents/caregivers as worse and who had more dental pain were more likely to have utilized oral health services in China.

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Health service utilization in immigrants with multiple sclerosis.

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Health service utilization in immigrants with multiple sclerosis.

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