Browsing School, Graduate by Subject "health care utilization"
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Antiparkinson Drug Use and Adherence, and the Impact on Medicare Part D Enrollees with Parkinson's diseaseStudy Objectives: To examine the prevalence of and factors associated with Antiparkinson drug (APD) use and adherence, and the association of APD use and adherence with healthcare utilization and expenditures in Medicare Part D enrollees with Parkinson's disease (PD). Methods: A retrospective observational study was conducted using the 2006-2007 Medicare Chronic Care Condition Warehouse data which represents a 5 percent sample of Medicare beneficiaries. The PD sample was selected with (1) at least 1 medical claim with an ICD-9 code 332.0 in two consecutive years; and (2) continuous enrollment in Medicare Parts A, B, and D from 6/1/2006 through 12/31/2007 or date of death. The total study interval was 579 days. APD use measures included any use, duration, and adherence (Medication Possession Ratio [MPR]). Factors associated with APD use measures were examined using modified-Poisson regressions with Generalized Estimating Equations. The association of APD use/adherence with utilization and expenditure outcomes was evaluated with negative binomial and gamma General Linear Models, respectively. Results: 12% of PD patients (n=8,758) did not use any APDs, and a fourth of APD users had a duration of therapy for 435 days or fewer and an MPR of less than 0.80. Patients with cognitive impairment and with 11 or more comorbidities were less likely to use APDs; and if using, they were less likely to possess APDs persistently and regularly. Other factors associated with not using APDs included low-income-subsidy eligibility and having no neurologist visits. Factors associated with poor adherence included older age (65 or older), non-white ethnicity, and having changes in APD therapy. Longer duration and higher adherence were associated with a reduced rate of all-cause utilization for acute (hospital and emergency room [ER]), chronic (Part A skilled nursing facility [SNF] and home health agency), and physician care (only for adherence). Similar patterns were found with PD-only and PD-related-comorbidities hospital, ER, and Part A SNF care. Also, significantly reduced total, Part A, and Part B, and increased Part D expenditures were observed in longer-duration users and in higher adherers. Conclusion: Significant reduction in healthcare utilization and expenditures could be achieved by improved duration of use and adherence to APDs.
Help-seeking Behavior among Working-age Adults with Suicidal Ideation: An integration of the Andersen Model of Health Care Utilization and the Three-stage Model of Mental Health Help-seekingDespite a high suicide rate among working-age adults, there is a significant lack of empirical evidence on suicide help-seeking among working-age adults. This dissertation examined help-seeking behavior among working-age adults between 26 and 65 years old who reported suicidal ideation in the past year (n = 1, 414). Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health (NSDUH) to examine three research questions: (1) What factors are related to help-seeking among adults with suicidal ideation; (2) Does the combined model of help-seeking fit for adults with suicidal ideation; and (3) What are the reasons for not receiving mental health treatment among the subset of adults with suicidal ideation who did not receive mental health treatment? Findings from multinomial logistic regression suggested that male gender, younger age, being non-white, being employed full-time, lower levels of mental health need, and not having health insurance were associated with not seeking help. The results also indicated where in the help-seeking pathway each risk factor is related to. Results from structural equational modeling analyses demonstrated that the combined model of help-seeking behavior fit reasonably well among the current sample. The examination of the relationships between predisposing/need/enabling factors and help-seeking behavior showed that each factor affects help-seeking behavior through its direct effects on help-seeking behavior and/or indirect effects on other factors. Among the subsample who reported unmet needs for mental health treatment, a burden of treatment cost, not knowing where to look for services, and negative attitudes toward treatment were most frequently reported reasons for not receiving treatment. The results provide a foundation for future help-seeking interventions and imply that health professionals need to continuously assess and respond to suicide risk among their clients. Efforts should be made to reach working-age adults with suicidal ideation but without a diagnosis of mental disorders as they are less likely to be in the mental health care system. Future studies should examine the role of suicidal ideation in the help-seeking pathway and how employment status and work environment impact help-seeking behavior among working-age adults with suicidal ideation.