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Rationale: Acute hypercapnic respiratory failure has been shown to be associated with worse outcomes for various disease states, but less is known about patients with compensated hypercapnic respir...

PURPOSE There is a substantial gap between people having a mental disorder and those treated for this disorder. Studies that assessed the influence of age on healthcare use for major depressive disorder (MDD) have provided inconsistent results. We aimed to assess healthcare use in terms of treatment-seeking and psychotropic medication use in four age groups of 45- to 85-year-old community dwellers meeting criteria for MDD. METHODS Data stemmed from CoLaus|PsyCoLaus, a population-based prospective cohort study. Diagnostic information on mental disorders, utilization of professional healthcare and psychotropic drugs was elicited using a semi-structured interview. Associations between age groups and healthcare use were established using logistic regression models with serial adjustments for socio-demographic and depression characteristics as well as comorbid mental disorders and cardio-metabolic features. RESULTS Compared to participants of the youngest age group (ages 45 to 54 years), (1) those older than 75 years were less likely to use healthcare from psychiatrists or psychologists (OR: 0.4 [95% CI 0.17-0.96]), although the frequency of using any professional health care did not vary across age groups; (2) those older than 55 years used any psychotropic medication more frequently; and (3) those aged 55-64 years used antidepressants more frequently (OR: 1.61 [95% CI 1.07-2.44]), whereas those aged 65-74 years used anxiolytics more frequently (OR: 2.30 [95% CI 1.15-4.58]). CONCLUSION Age is a complex biological and social factor that influences healthcare use.

Objective To examine the associations between post-traumatic stress of parents of infants with complex congenital heart defects and their healthcare use for their infants during the early months of life. Study design The current study is a secondary data analysis from a randomized controlled trial in which 216 parent–infant dyads were recruited from 3 cardiac intensive care units of large pediatric centers in Northeastern America. The current sample included 153 dyads with post-traumatic stress data at hospital discharge and at 4-months’ follow-up. Poisson regressions were used to estimate the effect of post-traumatic stress change scores on number of emergency department (ED) visits, unscheduled cardiologist visits, and unscheduled pediatrician visits outcomes. Results Infants whose parents gained post-traumatic stress disorder over the study period were at increased risk for ED visits and unscheduled cardiologist visits. Increased symptom severity predicted more unscheduled cardiologist visits and more unscheduled pediatrician visits. Increased symptom clusters (avoidance, arousal, re-experiencing) predicted more ED visits, more unscheduled cardiologist visits, and more unscheduled pediatrician visits. Conclusions Parents of infants with cardiac conditions may experience post-traumatic stress following cardiac surgery, which can be linked to greater healthcare use. Findings highlight the importance of screening and treating post-traumatic stress to preserve parental mental health and prevent adverse outcomes.

Background Rapid testing, tracing, and isolation among symptomatic patients are the standard for controlling the COVID‐19. However, during spring 2020, Japan employed a RT‐PCR test policy by using a guideline, which was used for the public to visit hospitals or clinics when they had mild symptoms for 4 days or longer (“4‐day rule”) among low‐risk patients. It is unknown of patients’ experience of healthcare use and testing during the period under the guideline. Thus, we investigated the healthcare visiting and testing among patients who developed cold‐like symptoms during the period. Methods Our survey was conducted online in September 2020 to a nationally representative sample of adults throughout Japan. We investigated the public's understanding of the guideline. In addition, we asked their experience with healthcare use and testing if they had noticed new‐onset cold‐like symptoms. Results Of 2,137 people surveyed, 1,698 (79.5%) recognized the guidelines, but 422 people (19.7%) misunderstood. There were 144 (6.7% of 2,137 people) who developed cold‐like symptoms, and many of them experienced difficulties in getting through telephone calls to a public health center, and 25 (17% of 144 people) visited healthcare institutions. Of these 25 symptomatic patients, 15 (60%) could not receive testing because of decisions by physicians (14 patients) or a local public health center (1 patient). Conclusion There was a low use of healthcare and testing among symptomatic patients during the first wave of the pandemic in Japan. Testing capacity should be increased to provide effective care for patients with suspected COVID‐19 in Japan.

Rationale: Pulmonary rehabilitation (PR) is the most effective strategy to improve health outcomes in people with chronic obstructive pulmonary disease (COPD), although it has had limited success i...

Background The Gallstone Pancreatitis: Admission vs Normal Cholecystectomy (Gallstone PANC) Trial demonstrated that cholecystectomy within 24 hours of admission (early) compared with after clinical resolution (control) for mild gallstone pancreatitis, significantly reduced 30-day length-of-stay (LOS) without increasing major postoperative complications. We assessed whether early cholecystectomy decreased 90-day healthcare use and costs. Study Design A secondary economic evaluation of the Gallstone PANC Trial was performed from the healthcare system perspective. Costs for index admissions and all gallstone pancreatitis-related care 90 days post-discharge were obtained from the hospital accounting system and inflated to 2020 USD. Negative binomial regression models and generalized linear models with log-link and gamma distribution, adjusting for randomization strata, were used. Bayesian analysis with neutral prior was used to estimate the probability of cost reduction with early cholecystectomy. Results Of 98 randomized patients, 97 were included in the analyses. Baseline characteristics were similar in early (n = 49) and control (n = 48) groups. Early cholecystectomy resulted in a mean absolute difference in LOS of -0.96 days (95% CI, -1.91 to 0.00, p = 0.05). Ninety-day mean total costs were $14,974 (early) vs $16,190 (control) (cost ratio [CR], 0.92; 95% CI, 0.73-1.15, p = 0.47), with a mean absolute difference of $1,216 less (95% CI, -$4,782 to $2,349, p = 0.50) per patient in the early group. On Bayesian analysis, there was an 81% posterior probability that early cholecystectomy reduced 90-day total costs. Conclusion In this single-center trial, early cholecystectomy for mild gallstone pancreatitis reduced 90-day LOS and had an 81% probability of reducing 90-day healthcare system costs.

Background Health insurance (HI) has increasingly been accepted as a mechanism to facilitate access to healthcare in low and middle-income countries. However, health insurance members, especially those in Sub-Saharan Africa, have reported a low responsiveness in health systems. This study aimed to explore the experiences and perceptions of healthcare services from the perspective of insured and uninsured elderly in rural Tanzania. Method An explanatory qualitative study was conducted in the rural districts of Igunga and Nzega, located in western-central Tanzania. Eight focus group discussions were carried out with 78 insured and uninsured elderly men and women who were purposely selected because they were 60 years of age or older and had utilised healthcare services in the past 12 months prior to the study. The interview questions were inspired by the domains of health systems’ responsiveness. Qualitative content analysis was used to analyse the data. Results Elderly participants appreciated that HI had facilitated the access to healthcare and protected them from certain costs. But they also complained that HI had failed to provide equitable access due to limited service benefits and restricted use of services within schemes. Although elderly perspectives varied widely across the domains of responsiveness, insured individuals generally expressed dissatisfaction with their healthcare. Conclusions The national health insurance policy should be revisited in order to improve its implementation and expand the scope of service coverage. Strategic decisions are required to improve the healthcare infrastructure, increase the number of healthcare workers, ensure the availability of medicines and testing facilities at healthcare centers, and reduce long administrative procedures related to HI. A continuous training plan for healthcare workers focused on patients´ communication skills and care rights is highly recommended.

Background The individual factors associated to Frequent Users (FUs) in Emergency Departments are well known. However, the characteristics of their geographical distribution and how territorial specificities are associated and intertwined with ED use are limited. Investigating healthcare use and territorial factors would help targeting local health policies. We aim at describing the geographical distribution of ED’s FUs within the Paris region. Methods We performed a retrospective analysis of all ED visits in the Paris region in 2015. Data were collected from the universal health insurance’s claims database. Frequent Users (FUs) were defined as having visited ≥3 times any ED of the region over the period. We assessed the FUs rate in each geographical unit (GU) and assessed correlations between FUs rate and socio-demographics and economic characteristics of GUs. We also performed a multidimensional analysis and a principal component analysis to identify a typology of territories to describe and target the FUs phenomenon. Results FUs accounted for 278,687 (11.7%) of the 2,382,802 patients who visited the ED, living in 232 GUs. In the region, median FUs rate in each GU was 11.0% [interquartile range: 9.5–12.5]. High FUs rate was correlated to the territorial markers of social deprivation. Three different categories of GU were identified with different profiles of healthcare providers densities. Conclusion FUs rate varies between territories and is correlated to territorial markers of social deprivation. Targeted public policies should focus on disadvantaged territories.

In a retrospective cohort study, among 131 773 patients with previous coronavirus disease 2019 (COVID-19), reinfection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) was suspected in 253 patients (0.2%) at 238 US healthcare facilities between 1 June 2020 and 28 February 2021. Women displayed a higher cumulative reinfection risk. Healthcare burden and illness severity were similar between index and reinfection encounters.

Question Does feeling reassured after a consultation reduce future disability or healthcare use in people with acute low back pain (LBP)? Design Mediation analysis of a randomised, sham-controlled trial. Participants Two hundred and two people with acute LBP at above average risk (high risk) of developing chronic LBP. Intervention All participants received guideline-based care from their usual clinician. Participants received two additional 1-hour sessions of patient education focused on emphasising the benign nature of LBP or sham patient education that included active listening only. Outcome measures The two primary outcomes for this study were self-reported disability and healthcare use. The mediator was feeling reassured that LBP was not caused by serious illness. Results Data from 194 (96%) participants and 178 (88%) participants were included in the analysis for disability and healthcare use outcome models, respectively. Feeling reassured did not mediate the effect of the intervention on disability (indirect effect −0.23, 95% CI −0.71 to 0.18) or healthcare use (indirect effect 0.00, 95% CI −0.04 to 0.04). Patient education intervention increased feeling reassured (1.14 points, 95% CI 0.43 to 1.85) compared with sham patient education. However, the mediator (ie, feeling reassured) did not reduce disability (−0.20 points, 95% CI −0.58 to 0.19) or healthcare use (OR 1.09, 95% CI 0.98 to 1.21). Conclusion Feeling reassured after a consultation did not lead to improvements in disability and healthcare use for people with acute LBP. Clinicians should reflect on the time that they allocate to reassuring their patients and consider reallocating time to other aspects of the consultation that could reduce disability and future healthcare use. Trial registration ACTRN12612001180808, study protocol https://osf.io/4tfaz/ .

Background: Multidisciplinary heart failure (HF) clinics decrease hospital admission rates and healthcare use, while improving patient outcomes. To understand the contemporary availability of HF clinics in Ontario, Canada, and the services provided, we performed an environmental scan of physician-led and nurse practitioner (NP)–led HF clinics. Methods: Between November, 2019 and February 2020, we identified Ontario HF clinics led by physicians or NPs. Following an invitation, we conducted a semi-structured interview to evaluate the services offered and qualitatively compared our findings to the results of the 2010 Ontario provincial survey. Results: The number of HF clinics (36 vs 34 in 2010) and physicians (157 vs 143 in 2010) have not changed since the 2010 survey. Of the 36 clinics we identified, 30 participated in our interview (22 physician-led and 8 NP-led). Twenty-five clinics (83%) were hospital-based, of which 9 (30%) were part of an academic institution. Comparisons of our findings to the 2010 study on 30 clinics show an approximately 3-fold increase (P

Home-delivered meals have shown considerable promise in overcoming nutritional challenges among homebound older adults facing food insecurity and the risk of diabetes, while nutrition counseling provides knowledge and skills for diabetes management. The purpose of this study was to identify the impact of a program combining nutrition counseling with home-delivered meals by examining the use of hospital services 6 months before and after participating in the program. This study included 1009 clients who are at risk for diabetes and who received home-delivered meals and nutrition counseling via Meals on Wheels in Fort Worth, Texas. Hospital service data were extracted from a regional claims database. Generalized linear models were performed to examine changes in use of hospital services 6 months before and after program participation. The mean number of emergency department visits and hospitalizations decreased from 0.69 to 0.50 (

BackgroundDespite the severe symptoms experienced by dying COPD patients, specialized palliative care (SPC) services focus mainly on cancer patients. We aimed to study the access to SPC that COPD and lung cancer (LC) patients receive and how that access affects the need for acute hospital care.MethodsA descriptive regional registry study using data acquired through VAL, the Stockholm Regional Council’s central data warehouse, which covers nearly all healthcare use in the county of Stockholm. All the patients who died of COPD or LC from 2015 to 2019 were included. T-tests, chi-2 tests, and univariable and multivariable logistic regression analyses were performed on the accumulated data.ResultsIn total, 6479 patients, (2917 with COPD and 3562 with LC) were studied. The patients with LC had more access to SPC during the last three months of life than did those with COPD (77% vs. 18%, respectively; p 2 = 287, p ConclusionsCompared to dying COPD patients, LC patients have more access to SPC. Access to SPC reduces the need for emergency room visits and admissions to acute hospitals.

Zusammenfassung Ziel der Studie Menschen mit geistiger Behinderung weisen eine geringere Lebenserwartung und häufigere Komorbidität als die Allgemeinbevölkerung sowie ungedeckte Gesundheitsbedarfe auf. Als ein Grund wird eine unzureichende medizinische Versorgung vermutet, wozu in Deutschland wenige Daten vorliegen. Die Studie widmet sich deshalb der Frage, wie Menschen mit geistiger Behinderung die medizinische Versorgung einschließlich Vorsorge und präventive Angebote in Anspruch nehmen. Methodik Querschnittstudie in 3 Werkstätten für Menschen mit geistiger Behinderung. Von Angehörigen wurde die Inanspruchnahme der Gesundheitsversorgung per Fragebogen erhoben. Die Auswertung erfolgte deskriptiv und inferenzstatistisch im Vergleich zur Allgemeinbevölkerung sowie innerhalb der Teilnehmenden auf soziodemografische Unterschiede. Ergebnisse Fast alle 181 Teilnehmer (Teilnahmequote 19,3%) haben einen Hausarzt. Im Vergleich zur Allgemeinbevölkerung nehmen die Teilnehmer die hausärztliche und die Versorgung durch zahlreiche andere Facharztgebiete häufiger in Anspruch. Die Krebsvorsorge für Dickdarm, Brust, Gebärmutterhals und Prostata nehmen sie seltener, für Haut und den Check-up öfter in Anspruch. Bei Zahnarztkontrollen und Maßnahmen der Gesundheitsförderung zeigt sich kein Unterschied. Teilnehmer aus Wohnheimen nehmen die Regelangebote mehr in Anspruch als die bei Angehörigen oder alleine Lebenden. Teilnehmer mit Migrationshintergrund kennen die Versorgungsangebote weniger gut. Schlussfolgerung Hinweise auf eine generelle gesundheitliche Unterversorgung zeigen die Ergebnisse nicht. Die Teilnahme an der Krebsvorsorge mit aufwändigeren Untersuchungen sollte gefördert werden, insbesondere für die allein oder bei Angehörigen lebenden Menschen mit geistiger Behinderung; Menschen mit Migrationshintergrund und ihre Angehörigen sollten gezielt informiert werden.

Rationale: Some reports indicate longitudinal variability in sputum differential cell counts, whereas others describe stability. Highly variable sputum eosinophil percentages are associated with greater lung function loss than persistently elevated eosinophil percentages, but elevated neutrophils are linked to more severe asthma.Objectives: To examine sputum granulocyte stability or variability longitudinally and associations with important clinical characteristics.Methods: The SARP III (Severe Asthma Research Program III) cohort underwent comprehensive phenotype characterization at baseline and annually over 3 years. Adult subjects with acceptable sputum levels were assigned to one of three longitudinal sputum groups: eosinophils predominantly 2 SDs determined from independent, repeated baseline eosinophil percentages). Subjects were similarly assigned to one of three longitudinal neutrophil groups with a 50% cut point.Measurements and Main Results: The group with predominantly

Women have consistently lower mortality rates than men at all ages and with respect to most causes. However, gender differences regarding hospital admission rates are more mixed, varying across ages and causes. A number of intuitive metrics have previously been used to explore changes in hospital admissions over time, but have not explicitly quantified the gender gap or estimated the cumulative contribution from cause-specific admission rates. Using register data for the total Danish population between 1995 and 2014, we estimated the time to first hospital admission for Danish men and women aged 60. This is an intuitive population-level metric with the same interpretive and mathematical properties as period life expectancy. Using a decomposition approach, we were able to quantify the cumulative contributions from eight causes of hospital admission to the gender gap in time to first hospital admission. Between 1995 and 2014, time to first admission increased for both, men (7.6 to 9.4 years) and women (8.3 to 10.3 years). However, the magnitude of gender differences in time to first admission remained relatively stable within this time period (0.7 years in 1995, 0.9 years in 2014). After age 60, Danish men had consistently higher rates of admission for cardiovascular conditions and neoplasms, but lower rates of admission for injuries, musculoskeletal disorders, and sex-specific causes. Although admission rates for both genders have generally declined over the last decades, the same major causes of admission accounted for the gender gap. Persistent gender differences in causes of admission are, therefore, important to consider when planning the delivery of health care in times of population ageing. Supplementary Information The online version contains supplementary material available at 10.1007/s10433-021-00614-w.

Frailty and multimorbidity are interrelated complex syndromes. Individuals living with frailty are likely to be multimorbid, but not all multimorbid individuals are frail. Frailty and multimorbidity are principal causes of polypharmacy. In combination, they are associated with significant healthcare use, unscheduled hospital admissions and mortality. However, multiple medication use is not always inappropriate. Early detection of frailty, patient-centred decision-making and review of multimorbid conditions underpinned by principles of comprehensive geriatric assessment are the cornerstones of patient management.

This article evaluates the effects of the Health Insurance for the Poor program, Askeskin, using panel data from the 2000 and 2007 rounds of the Indonesian Family Life Survey (IFLS). Because Askesk...

Introduction. Since 1987, there has been little information on oral health (OH) status of young adults aged 19 to 26 in Serbia. This study aimed to investigate the trends in OH status and OH-related quality of life (OHRQoL) of undergraduate student population in Belgrade in 2012. Materials and methods. The study included a total of 699 students of different study fields who underwent a dental examination, with 530 of them agreeing to an assisted survey and 275 forgoing a periodontal assessment. The survey consisted of six sections - basic information, socio-demographic data, oral healthcare use and habits, risk factors, OH self-assessment and OHRQoL. Clinical assessment was performed using the Decayed, Missing, Filled teeth (DMFT) index; Gingival Index; Clinical Attachment Level; Community Periodontal Index, and Plaque index. OHRQoL was evaluated through a modified OH Impact Profile (OHIP-14). Results. The mean DMFT of the examined population was 10.24 (standard deviation [SD] 5.33). Students from East and South Serbia (DMFT=8.69 [SD=4.93]), technical study field (DMFT=8.84 [SD=4.94]), with mother?s having a university degree (DMFT=9.33 [SD=5.15]) and with satisfactory OH (DMFT=8.94 [SD=4.76]) were all significantly associated with lower DMFT. A significantly lower OHRQoL score was observed in students with satisfactory self-reported OH (Score=9.48 [SD=1.44]). The periodontal assessment showed no significant differences across all values of observed indexes. Conclusion. The mean DMFT of Belgrade?s young adults? population has decreased from 1987 to 2012 from 12.5 to 10.4. Self-reported OH is significantly associated with both the DMFT values and OHRQoL.

Objective: To examine the prevalence and healthcare use of acute respiratory tract infections (RTIs) among cancer survivors in the United States in a population-based cohort. Methods: Medical Expen...

Aim: To evaluate the impact of chronic non-cancer pain (CNCP) on healthcare use and costs among individuals diagnosed with obstructive sleep apnea (OSA). Materials & methods: Using the IQVIA PharMetrics® Plus database, we identified individuals (18–64 years old) during 2007–2014, divided into two groups: OSA + CNCP versus OSA-only. Generalized linear models were used to analyze binary and count outcomes. Results: Relative to OSA-only controls, OSA + CNCP cases had increased odds for inpatient and emergency department visits and higher rates for physician office visits, non-physician outpatient visits, and prescription drug fills. Relative to controls, direct healthcare costs for cases were higher, primarily driven by inpatient and non-physician outpatient visit costs. Conclusion: Relative to OSA-only controls, OSA + CNCP cases displayed increased healthcare use and costs across all points of service.

This study aimed to compare sickness absenteeism, work performance, and healthcare use due to respiratory infections, as well as general sickness absenteeism and work performance between shift and non-shift workers. In this study, 589 shift and non-shift workers employed in hospitals were included. For 6 months, participants kept a daily record of their influenza-like illness/acute respiratory infection (ILI/ARI) symptoms using a diary application. After an episode of ILI/ARI symptoms ended, participants (n = 531) were questioned about their sickness absenteeism (occurrence and duration in hours), work performance (on a 10 point scale), and healthcare use during the ILI/ARI episode. At the end of the 6 months follow-up, participants (n = 498) were also asked about general sickness absenteeism and work performance in the past 4 weeks. Mixed-model and regression analyses were used to compare absenteeism, work performance, and healthcare use between shift and non-shift workers. No differences were found in sickness absenteeism [Odds Ratio (OR) = 1.00 (95%‒Confidence Interval (CI): 0.61‒1.64)] and work performance [Regression coefficient (B) = −0.19 (95%‒CI: −0.65‒0.26)] due to ILI/ARI between shift and non-shift workers. In addition, healthcare use due to ILI/ARI was similar between shift and non-shift workers. Furthermore, similar general sickness absenteeism rates and work performance levels were found between shift and non-shift workers. As this is the first study that examined the associations with shift work due to ILI/ARI, further studies are needed to confirm our findings.

Background: Mismatch between need and mental healthcare (MHC) use (under-and overuse) has mainly been studied with cross-sectional designs, not accurately capturing patterns of persistence or change in clinical burden and MHC-use among persons with depressive and/or anxiety disorders. Aims: Determining and describing [mis]match of longitudinal trajectories of clinical burden and MHC-use. Methods: Six-year longitudinal burden and MHC-use data came from the Netherlands Study of Depression and Anxiety (n=2981). The sample was split into four subgroups: I) no clinical burden but constant MHC use, II) constant clinical burden but no MHC-use, III) changing clinical burden and MHC-use, and IV) healthy non-users. Within subgroups I)-III), specific clinical burden and MHC trajectories were identified (growth mixture modeling). The resulting classes’ associations with predisposing, enabling, and need factors were investigated (regression analysis). Results: Subgroups I-III revealed different trajectories. I) increasing MHC without burden (4.1%). II) slightly increasing (1.9%), strongly increasing (2.4%), and decreasing (9.5%) burden without MHC. III) increasing (41.4%) or decreasing (19.4%) burden and concurrently increasing MHC use (first underuse, then matched care), thus revealing delayed MHC-use. Only having suicidal ideation (p

Aim: We aimed to understand the interplay between retirement pathways and healthcare use in the postponed and structurally changing context of retirement. Methods: Based on Swedish register data on income and healthcare use, we applied combined sequence and cluster analysis to identify typical pathways into retirement and analysed their relation to healthcare use developments. Results: We detected five distinct pathways into retirement. Level of healthcare use was significantly higher for the pathway via disability pensions. We saw an overall increase in healthcare use across the retirement process that was related to age rather than to the different pathways. Conclusions: Level of healthcare use at the beginning of the retirement process may be related to selection into different pathways of retirement. We did not find clear evidence across several healthcare measures that different pathways lead to different developments in healthcare use. Funding agencies: Martin Wetzel received a mobility grant from theExcellence Initiative of the University of Cologne,Germany for his research stay at the LinköpingUniversity. The authors received no further financialsupport for the research, authorship, and/or publication of this article.

INTRODUCTION: COVID-19 has had a profound effect on the NHS. Little information has been published as to how the unselected medical take has been affected. METHODS: We retrospectively reviewed patients who were referred to general medicine during March 2020. We compared clinical outcomes of patients with and without COVID-19. RESULTS: 814 patients were included, comprising 777 unique patients. On average, 26 patients were admitted per day. 38% of admitted patients were suspected of COVID-19, with greater numbers of COVID-19 patients in the second half compared to the first half of the month (p

Life-space mobility (LSM) is a concept for assessing patterns of functional mobility over time. LSM is gaining traction in the research of geriatric population health. Several instruments have been developed to measure LSM, such as the University of Alabama at Birmingham Life-Space Assessment (LSA) or the Nursing Home Life-Space Diameter instrument. There has been exponential growth in the use of instruments measuring LSM in studies of older adults since the concept was introduced in 1985. In response to the increased volume of publications with clinical applicability to those working in geriatric health or conducting population-based research in older adults, we conducted a narrative review: a) to provide a summary of the articles that have assessed validation of the University of Alabama at Birmingham LSA instrument, the most widely used instrument to assess LSM in older adults; and b) to provide a summary of the research articles that have examined LSM as independent or outcome variable. Studies for this review were obtained with an organized search format and were included if they were published in the past 20 years, written in English, published in peer-reviewed literature, and included LSM as an independent or outcome variable. Seventy-nine articles were identified: 36 that employed a cross-sectional design and 22 that employed a longitudinal/prospective design to examine LSM as outcome variable; 17 longitudinal/prospective design articles that examined LSM as primary independent variable; 3 review articles; and 1 systematic review. Areas of research included physical function, cognitive function, sensory impairment, mental health, falls, frailty, comorbidities, healthcare use, mortality, and social/environmental factors. These studies showed that LSM instruments can accurately predict morbidity, mortality, and healthcare use.

OBJECTIVES Compare patient characteristics by hospital discharge disposition (home without services, home with home healthcare (HHC) services, or post-acute care (PAC) facilities). Examine timing and rates of 30-day healthcare utilization (rehospitalization, emergency department (ED) visit, or observation (OBS) visit) and patient characteristics associated with rehospitalization by discharge location. DESIGN Retrospective analysis of hospital administrative and clinical data. SETTING AND PARTICIPANTS A total of 3,294 older adult inpatients discharged home with or without HHC services or to a PAC facility. MEASUREMENTS Patient-level sociodemographic and clinical characteristics. Number of and time to occurrences of rehospitalization or ED/OBS visit within 30 days of hospital discharge. RESULTS Most rehospitalizations and ED/OBS visits occurred within 14 days from hospital discharge. Patients who returned within 24 hours came mostly from inpatient rehabilitation facilities (IRFs). More intense levels of PAC services were linked with higher rehospitalization risk. However, specific predictors differed by discharge location. Being unemployed, being single, and having more comorbidities were most associated with rehospitalization in those who went home with or without services, whereas patients rehospitalized from IRFs were younger, with less chronic illness burden, but greater and recent functional decline. Those discharged with HHC services had more return ED/OBS visits. CONCLUSIONS Although sicker patients were referred for more intense levels of PAC services, patients with greater chronic illness burden were still most often rehospitalized. In addition to unique patient differences, rehospitalizations from IRF within 24 hours suggest systems factors are contributory. Most return acute healthcare utilization occurred within 14 days; therefore, interventions should focus on smoothing transitions to all discharge locations. Because predictors of rehospitalization risk differed by discharge disposition, future research is necessary to study approaches aimed at matching patients' care needs with the most suitable PAC services at the right time. J Am Geriatr Soc 68:2279-2287, 2020.

Objective: To determine the government and out‐of‐pocket community costs (out‐of‐hospital medical services and prescription medicines) associated with screen‐detected and community‐detected cancers (i.e. cancers detected outside of Australia's organised screening program [BreastScreen]). Methods: We analyse administrative data on government‐subsidised medical services and prescription medicines for 568 Victorian women diagnosed with breast cancer or ductal carcinoma in situ (DCIS). Using multivariable regression analysis, we estimate the government and out‐of‐pocket community costs incurred in the three years after diagnosis for screen‐detected cancers and community‐detected cancers. Additionally, we estimate the government costs associated with diagnosis within and outside of BreastScreen. Results: Average government costs for breast cancer diagnosis were similar within and outside of BreastScreen [$808 (lower limit 676; upper limit 940) vs $837 (95%CI 671; 1,003) respectively]; however, women with community‐detected cancers incurred an additional $254 (95%CI 175; 332) out‐of‐pocket. Controlling for differences in known cancer characteristics, compared to screen‐detected cancers, community‐detected breast cancers were associated with an additional $2,622 (95%CI 644; 4,776) in government expenditure in the three years following diagnosis. Adverse cancer characteristics that were more prevalent in community‐detected cancers (high grade, lymph node involvement, HER2 positive receptor status) were associated with increased government and out‐of‐pocket costs. Conclusions: Community‐detected breast cancers were associated with increased government and out‐of‐pocket costs. Implications for public health: These costs should be considered when evaluating current and alternative breast cancer screening strategies.

Background/Aim: To quantify the association between a previous cancer diagnosis and healthcare use among breast cancer (BC) patients, and estimate five-year recurrence-free survival (RFS). Patients and Methods: Women with BC were classified according to a previous cancer diagnosis (BC or other). Healthcare use during the first year and five-year RFS were obtained through clinical and administrative records. Adjusted odds ratios and hazard ratios (HR) were estimated. Results: Among 681 BC patients, 21 had a previous BC and 32 a previous non-BC. The latter were less likely to receive anthracycline-based combination chemotherapy. The former had higher odds of mastectomy and genetic testing. Five-year RFS HRs (95% confidence interval) were 2.75 (0.79-9.52) and 0.52 (0.07-3.89) for previous BC and non-BC, respectively. Conclusion: Previous cancer was associated with less anthracycline-based combination chemotherapy, and patients were more likely to undergo mastectomy and genetic testing. These findings highlight the need for assessment of previous treatments, personal genetic risk and current BC characteristics. This study was funded by FEDER through the Operational Programme Competitiveness and Internationalization and national funding from the Foundation for Science and Technology – FCT (Portuguese Ministry of Science, Technology and Higher Education), under the project “A five-year prospective cohort study on the neurological complications of breast cancer: frequency and impact in patient reported outcomes” (POCI-01-0145-FEDER-016867; ref. PTDC/DTP-EPI/7183/2014), and the Unidade de Investigação em Epidemiologia – Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; ref. UID/DTP/04750/2019). SM and LC were also funded under the scope of the project "NEON-PC -Neuro-oncological complications of prostate cancer: longitudinal study of cognitive decline" (POCI-01-0145-FEDER-032358; ref.PTDC/SAU-EPI/32358/2017). Individual grants attributed to ARC (SFRH/BD/102181/2014) and NA (SFRH/BD/119390/2016) were co-funded by FCT and the Programa Operacional Capital Humano (POCH/FSE). Data management activities up to the first year of follow-up were supported by the Chair on Pain Medicine of the Faculty of Medicine, University of Porto and by the Grünenthal Foundation – Portugal.

Context: Patients treated with maintenance hemodialysis experience significant symptom burden resulting in impaired quality of life. However, the association of patient reported symptom burden and the risk of healthcare use for patients with end stage kidney disease on hemodialysis has not been fully explored. Objectives: To investigate if higher symptom burden, assessed by the Edmonton Symptom Assessment System-revised (ESASr), is associated with increased healthcare use in patients with end stage kidney disease on hemodialysis. Methods: Prospective, single-center, study of adult patients on HD. Participants completed the ESASr questionnaire at enrollment. Baseline demographic, clinical information as well as healthcare use events during the 12-month following enrollment were extracted from medical records. The association between symptom burden and healthcare use was examined with a multivariable adjusted negative binomial model. Results: Mean (SD) age of the 80 participants was 71 (13) years, 56% diabetic, and 70% male. The median (IQR) dialysis vintage was 2 (1–4) years. In multivariable adjusted models, higher global [incident rate ratio (IRR) 1.02, 95% confidence interval (CI) 1.00–1.04, p = .025] and physical symptom burden score [IRR 1.03, CI 1.00–1.05, p = .034], but not emotional symptom burden score [IRR 1.05, CI 1.00–1.10, p = .052] predicted higher subsequent healthcare use. Conclusions: Our preliminary evidence suggests that higher symptom burden, assessed by ESASr may predict higher risk of healthcare use amongst patients with end stage kidney disease on hemodialysis. Future studies need to confirm the findings of this preliminary study and to assess the utility of ESASr for systematic symptom screening.

Cross-border healthcare use among elderly Turkish migrants living in Denmark has been of concern in regards to their compliance with Danish healthcare provisions. A qualitative study of 30 elderly Turkish migrants was conducted, and the analysis led to the construction of two types of users: acute and intentional. The acute users respected the authority of the Danish healthcare system and only sought the use of healthcare services in acute situations whilst in Turkey. In contrast, the intentional users planned to consult and buy healthcare services whilst in Turkey. It was concluded that national health authorities should acknowledge and appreciate the benefits of transnational health practices represented by those groups of migrants who, in cooperation with their doctors, are competent users of cross-border healthcare services. The results of this study call attention to scholars of health and migration to be aware of our own ‘concerns’, which may represent spots of blindness hindering important and surprising insights.

Aim: To evaluate the rates of infection and nonunion and determine the impact of infections on healthcare resource use and costs following open and closed fractures of the tibial shaft requiring open reduction internal fixation. Methods: Healthcare use and costs were compared between patients with and without infections following pen reduction internal fixation using MarketScan ® databases. Results: For commercial patients, the rates of infection and nonunion ranged from 1.82 to 7.44% and 0.48 to 8.75%, respectively, over the 2-year period. Patients with infection had significantly higher rates of hospital readmissions, emergency room visits and healthcare costs compared with patients without infection. Conclusion: This real-world study showed an increasing rate of infection up to 2 years and infection significantly increased healthcare resource use and costs.

Purpose To analyze the impact of a 12-week extended International Normalized Ratio (INR) follow-up interval on healthcare use. Methods A prospective cohort study of the use of an extended INR follow-up interval of up to 12 weeks was conducted over 2 years in a pharmacist-managed anticoagulation clinic. A detailed protocol was used to extend the INR follow-up interval to 5–6 weeks and then 7–8 weeks and 11–12 weeks. The number of planned and unplanned anticoagulation encounters, procedures requiring warfarin interruption, telephone triage phone calls, emergency department visits, and hospitalizations were collected. A post hoc subanalysis was also completed on participants who were scheduled for 4 consecutive 12-week intervals. Results Compared to baseline, at 12 months there was a mean decrease in planned anticoagulation encounters of 2.24 visits (p < 0.001) among 44 participants. From 12 to 24 months compared to baseline, there was a mean decrease in planned anticoagulation encounters of 3.13 visits (p < 0.001) and an increase of 0.54 unplanned anticoagulation encounters (p = 0.04) among 39 participants. The remainder of healthcare use variables were not statistically significantly different from baseline at any time point. Of the 15 participants scheduled for 4 consecutive 12-week intervals, there was a decrease from baseline of approximately 5 visits over the course of a year (p < 0.001). Conclusion An extended INR follow-up interval appears to decrease anticoagulation healthcare use without an increase in acute healthcare use. While this intervention could be cost-effective, institutions need to consider safety, efficacy, and feasibility prior to implementation.

PURPOSE OF REVIEW Comorbidities are a common feature in epilepsy, but neither the entire spectrum nor the significance of such comorbidities has been fully explored. We review comorbidities associated with epilepsy and their associated burden, provide an overview of relationships, and discuss a new conceptualization of the comorbidities. RECENT FINDINGS The epidemiology of the comorbidities of epilepsy and effects on health outcomes, healthcare use, and healthcare expenditures have been partly delineated. Distinct mechanisms of the associations have been suggested but not entirely ascertained. Movement from conceptualizing epilepsy as a condition to a symptom-complex has occurred. SUMMARY Comorbidities are common among people with epilepsy and are associated with poorer clinical outcomes and quality of life, greater use of health resources, and increased expenditure. Becoming aware of the associated mechanisms and their uncertainty is central to understanding the relationships between epilepsy and comorbid health conditions, which have implications for diagnosis and screening, medical management, and surgical management. Conceptualizing comorbidities of epilepsy as precipitating factors and epilepsy as the symptom will improve the understanding of epilepsy and catalyze research and improvements in clinical practice.

Simple Summary Adolescent and young adult cancer survivors face several significant physical/mental health late effects following cancer treatment. These effects may be minimized through healthcare use tailored to young survivors’ needs. Using a cross-sectional study design, we examined the healthcare use of 93 adolescent/young adult cancer survivors (aged 15–39 years), relative to a comparison group of adolescents and young adults recruited from the local community (n = 183). Our cancer survivor group reported greater use of medical and mental health services, and medications during the past six months relative to the comparison group. Our cancer survivor group also reported less psychological distress, and similar work/study participation relative to the comparison group. Survivors who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater healthcare use. Future research is needed to determine whether the healthcare accessed by adolescent and young adult cancer survivors is appropriate and meets their needs. Abstract Healthcare use (HCU) during survivorship can mitigate adolescent and young adult (AYA) cancer survivors’ (aged 15–39 years) risk of medical and psychosocial late effects, but this is understudied. We surveyed 93 Australian AYA post-treatment cancer survivors (Mage = 22.0 years, SD = 3.5; 55.9% female) and a comparison sample of 183 non-matched AYAs (Mage = 19.7, SD = 3.2; 70.5% female) on their HCU, medication use, depression/anxiety, and general functioning. Relative to our comparison AYAs, a higher proportion of our survivor group reported medical HCU (community-delivered: 65.6% versus 47.0%, p = 0.003; hospital-delivered: 31.2% versus 20.3%, p = 0.044) and mental HCU (53.8% vs. 23.5%; p < 0.0001) in the past six months. A higher proportion of our survivors reported taking medications within the past six months than our comparison AYAs (61.3% vs. 42.1%, p = 0.003) and taking more types (p < 0.001). Vitamin/supplement use was most common followed by psychotropic medications. Our survivor group reported lower depression (p = 0.001) and anxiety symptoms (p = 0.003), but similar work/study participation (p = 0.767) to our comparison AYAs. Across groups, psychological distress was associated with higher mental HCU (p = 0.001). Among survivors, those who were female, diagnosed with brain/solid tumors and who had finished treatment more recently reported greater HCU. Future research should establish whether this level of HCU meets AYAs’ survivorship needs.

This research aimed to determine the health care cost and utilisation of older Australian women with osteoporosis. A wide range of healthcare services were used and approximately AU$593.9 was spent over a 12-month period for these services. This highlights the significant cost burden of osteoporosis on the healthcare system. PURPOSE: Osteoporosis is a common skeletal condition among women that has a considerable impact on quality of life. The purpose of this study is to determine the prevalence of healthcare use and to estimate associated out-of-pocket expenditure for the management of osteoporosis in older Australian women. METHODS: Data was obtained from 393 Australian women from the 45 and Up Study who had osteoporosis. The women were asked about healthcare use for their osteoporosis, including conventional medicine, complementary medicine, and self-care practices or self-care products, and associated out-of-pocket expenditure for that use over 12 months. RESULTS: The average age of participants was 72.0 years. Over a 12-month period, the majority of participants (72%) consulted a doctor for their osteoporosis, 24% consulted an allied health practitioner, and 20% consulted a complementary medicine practitioner. Participants had a mean of 6.8 consultations with healthcare practitioners in the previous 12 months for the osteoporosis. In addition, 46% participants used three or more types of complementary medicine products/practices in the previous 12 months. Overall, the participants incurred a (arithmetic) mean ofAU$594 (median = $350; inter-quartile range = $450) in out-of-pocket expenditure for healthcare use over the 12-month period. CONCLUSIONS: Women with osteoporosis use a wide range of healthcare services that are associated with significant annual out-of-pocket expenditure. Preventive strategies can help decrease the cost burden of osteoporosis on the healthcare system.

Key summary points Aim To investigate the extent to which Dutch older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic. Findings One third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. Message Delay of routine care during the pandemic may impact morbidity and related adverse outcomes in the long term, which should be monitored in future research., Purpose Delay of routine medical care during the COVID-19 pandemic may have serious consequences for the health and functioning of older adults. The aim of this study was to investigate whether older adults reported cancellation or avoidance of medical care during the first months of the COVID-19 pandemic, and to explore associations with health and socio-demographic characteristics. Methods Cross-sectional data of 880 older adults aged ≥ 62 years (mean age 73.4 years, 50.3% female) were used from the COVID-19 questionnaire of the Longitudinal Aging Study Amsterdam, a cohort study among community-dwelling older adults in the Netherlands. Cancellation and avoidance of care were assessed by self-report, and covered questions on cancellation of primary care (general practitioner), cancellation of hospital outpatient care, and postponed help-seeking. Respondent characteristics included age, sex, educational level, loneliness, depression, anxiety, frailty, multimorbidity and information on quarantine. Results 35% of the sample reported cancellations due to the COVID-19 situation, either initiated by the respondent (12%) or by healthcare professionals (29%). Postponed help-seeking was reported by 8% of the sample. Multimorbidity was associated with healthcare-initiated cancellations (primary care OR = 1.92, 95% CI = 1.09–3.50; hospital OR = 1.86, 95% CI = 1.28–2.74) and respondent-initiated hospital outpatient cancellations (OR = 2.02, 95% CI = 1.04–4.12). Depressive symptoms were associated with postponed help-seeking (OR = 1.15, 95% CI = 1.06–1.24). Conclusion About one third of the study sample reported cancellation or avoidance of medical care during the first months of the pandemic, and this was more common among those with multiple chronic conditions. How this impacts outcomes in the long term should be investigated in future research.

Objective To describe national trends in cholesteatoma management. Study design and setting Retrospective analysis Optum Clinformatics® Database from 2003 to 2019. Patients 16,179 unique adult and pediatric patients who received cholesteatoma surgery. Interventions and main outcome measures Patients were categorized into three groups by initial surgical modality: canal wall down (CWD), canal wall up (CWU), and tympanoplasty without mastoidectomy (TnoM). Three major comparisons between groups were performed: 1) temporal trends, 2) clinical and sociodemographic determinants, and 3) healthcare use in terms of total costs and incidence of postoperative imaging and subsequent surgery. Results Overall, 23.2% received initial CWD surgery, 44.3% CWU, and 32.5% TnoM. 1) The incidence of initial CWD surgery decreased (odds ratios [OR] = 0.98, 95% confidence intervals [CI] [0.97,0.99]), while CWU increased (OR = 1.02, 95% CI [1.01,1.03]), and TnoM remained stable over the study period (OR = 0.99, 95% CI [0.98,1.00]). 2) Relative to CWU, TnoM surgery was less likely in adults, patients with prior complications, and non-White patients, while being more likely in patients with higher household income. CWD was more likely than CWU in adults, patients with prior complications, and non-White patients, while income had no effect. 3) Postoperative costs for CWU and CWD were similar. In 2 years following initial surgery, postoperative imaging and/or subsequent surgery was performed in 45.48% of CWD, 57.42% of CWU, and 41.62% of TnoM patients. Conclusions Incidence of initial CWD surgery decreased and social disparities in cholesteatoma management were observed. Postoperative imaging or second-look surgery were performed in less than 60% of patients with initial CWU surgery and over 40% of patients with initial CWD.

Résumé Position du problème L’épidémie de Covid-19 du printemps 2020 a fortement affecté le système de soins. Le confinement et les risques d'exposition au coronavirus ont incité les patients à modifier leur recours aux soins. L'objectif était de partager un retour d'expérience sur la mise en place d'un dispositif de surveillance en temps réel de l'activité des médecins libéraux de la région Provence-Alpes-Côte d'Azur, et de l’évolution des remboursements de médicaments prescrits aux assurés du régime général pour le diabète, pour des troubles de la santé mentale et pour certains vaccins. Méthodes Les données ont été extraites à partir des bases régionales de l'Assurance maladie pour les années 2019 et 2020. Elles ont permis de construire des indicateurs en date de soins pour le régime général stricto sensu, calculés de façon hebdomadaire, à partir de la semaine 2. Résultats On constate une chute d'activité des médecins libéraux lors du confinement (-23 % pour les médecins généralistes ; -46 % pour les spécialistes), suivie d'un quasi retour à la normale par la suite. Dans le même temps, les téléconsultations ont connu un véritable essor : elles ont constitué 30 % des actes des médecins libéraux au plus fort de la crise. Le début du confinement a été marqué par un pic d'approvisionnement en médicaments, tandis que la vaccination a fortement diminué (-39 % concernant le vaccin contre la rougeole, les oreillons et la rubéole chez les enfants de moins de 5 ans ; -54 % pour le vaccin contre les papillomavirus humains chez les filles de 10-14 ans). Conclusion L’épidémie de Covid-19 risque d'entraîner d'autres conséquences sanitaires que celles directement imputables à la Covid-19 elle-même. Le renoncement aux soins pourrait causer des retards de soins fortement préjudiciables aux individus et à la collectivité. Ces questions inquiètent les autorités publiques, qui mettent en place des actions visant à inciter les patients à se soigner sans tarder. Mais la crise liée à la Covid-19 a aussi créé des opportunités, telles que le déploiement de la téléconsultation et de la téléexpertise. Bien que partiels, les indicateurs mis en œuvre peuvent permettre aux décideurs publics d’être réactifs et de mettre en place certaines actions afin de répondre aux besoins de santé des populations.

Colorectal cancer (CRC) has negative long-term impacts on survivors' health and work capacity. We aimed to investigate specialized healthcare use and sickness absence and disability pension among CRC survivors and matched references.In this longitudinal register-based cohort study, 6679 patients with a first primary CRC in 2008-2011 (when aged 18-62) and 26,716 CRC-free matched references were followed from 2 years before up to 5 years after diagnosis date. Mean numbers of hospital days and outpatient visits were illustrated for survivors and references for the 7-year period. Crude and adjusted mean numbers of sickness absence/disability pension net days were calculated for post-diagnosis Years 3 and 5.Survivors' healthcare use was higher compared to their references throughout the 7 years around CRC diagnosis and was mostly due to CRC, secondary neoplasms, and digestive disorders. In Year 5, survivors had 1.94 mean outpatient visits and 2.13 mean inpatient days (compared to 1.00 and 0.82 for references, respectively). Survivors' adjusted mean sickness absence/disability pension days amounted to 85 d in Year 3 and 77 in Year 5 (compared to 57 and 54 d in the references). Higher mean number of future days was found among women, lower-educated, foreign-born, with previous comorbidities or previous mental disorders. Those with many sickness absence days in 2 years pre-diagnosis had the highest number of future sickness absence/disability pension days.Post-diagnostic healthcare use remained high among CRC survivors, mostly due to cancer (CRC and other neoplasms) and digestive diagnoses. Their sickness absence and disability pension decreased gradually over the period but remained higher than among references. Pre-morbid characteristics may be used in early work-related clinical planning for the survivors.

Background: Depressive symptoms in patients with cardiovascular disease (CVD) can lead to increased healthcare use and cause an economical burden for society. Thus, interventions aiming to decrease depressive symptoms in these patients could reduce the use of healthcare services. In a previous study we reported that a 9-week internet-delivered cognitive behavioural therapy (iCBT) program (n=72) compared to an online discussion forum (ODF) (n=72) had moderate to large effect on depression in CVD outpatients. However, the associations between healthcare use and depressive symptoms were not reported in that study. The aim of this study was to describe and compare the effect of iCBT compared to ODF regarding healthcare use and to identify factors impacting healthcare use in these groups.Methods: Secondary analysis of a RCT. Data on healthcare use (including outpatient clinic/primary care contacts and hospital admissions) were retrieved from care data registries in five hospitals in Southeastern Sweden. Patients were predominantly males in both groups with a mean age of 61±13 and 64±12 years in iCBT and ODF respectively.Results: The year before the intervention, the iCBT group had a mean of 31 outpatient contacts per patient compared with 21 contacts the year after. The corresponding numbers for the ODF group were 37 and 25. The decrease was 32% in both groups and did not differ significantly between the groups.Regarding hospital admissions, the iCBT group had 0.8 admissions per patient the year before and 0.6 the year after the intervention, i.e. a decrease by 25%, whereas the ODF group had 1.1 and 0.6 admissions respectively, i.e. a decrease by 45%. The difference was not significant between the groups.Improvement in depressive symptoms post intervention was significantly associated with a decrease in number of outpatient contacts in the iCBT group. In the ODF group, better mental health-related quality of life post intervention was significantly associated with a decrease in number of hospital admissions.Conclusions: Reduced depressive symptom scores following intervention were associated with lower outpatient service use, but iCBT was not superior compared to ODF in decreasing healthcare use.Trial registration: The study was registered at ClinicalTrials.gov, NCT02778074.

The aim was to give an overview of longitudinal observational studies investigating the determinants of healthcare use explicitly using the Andersen model. To this end, three electronic databases (Medline, PsycINFO and CINAHL) were searched (and an additional hand search was performed). Longitudinal observational studies examining the determinants of healthcare use (outpatient physician services and hospital stays) based on the Andersen model were included, whereas disease-specific samples were excluded. Study quality was evaluated. The selection of studies, extraction of data and assessment of the studies were conducted by two reviewers. The following determinants of healthcare use were displayed based on the (extended) Andersen model: predisposing characteristics, enabling resources, need factors and psychosocial factors. In sum, n = 10 longitudinal studies have been included in our systematic review. The included studies particularly showed a longitudinal association between increased needs and higher healthcare use. Study quality was rather high. However, several studies did not conduct robustness checks or clarify the handling of missing data. In conclusion, this systematic review adds to our current understanding of the factors associated with healthcare use (mainly based on cross-sectional studies). It showed mixed evidence with regard to the association between predisposing characteristics, enabling resources and healthcare use longitudinally. In contrast, increased need factors (in particular, self-rated health and chronic conditions) were almost consistently associated with increased healthcare use. This knowledge may assist in managing healthcare use. Since most of the studies were conducted in North America or Europe, future longitudinal studies from other regions are urgently required.