Social Isolation Associated with Future Health Care Utilization

Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on health care utilization. However, the overall picture of shifts in health care utilization remains unclear. Objective We assessed the ecology of medical care during the COVID-19 pandemic in Japan and compared it with the results pre-pandemic. We also investigated the associations of sociodemographic and clinical factors with health care utilization during the COVID-19 pandemic. Design and Methods We conducted a nationwide cross-sectional survey of a representative sample of the general Japanese adult population in May 2021. The main outcomes were health care utilization for health-related events in the last month. We assessed sociodemographic and clinical factors, including age, sex, years of education, annual household income, social isolation, and the number of chronic conditions. Key Results Data were analyzed from 1747 respondents. Over-the-counter drug use, physician’s office visits, and hospital outpatient clinic visits decreased drastically during the COVID-19 pandemic compared with pre-pandemic levels. The decrease in the use of medical facilities was especially pronounced among the elderly. Sociodemographic and clinical factors were differently associated with health care utilization during the COVID-19 pandemic. Social isolation and years of education were positively associated with over-the-counter drug use, while female sex was associated with increased over-the-counter drug use and physician’s office visits. In addition, the number of chronic conditions was associated with increased hospital visits. Conclusions During the COVID-19 pandemic, the use of medical facilities for health-related events decreased drastically, especially among the elderly. A pharmacy is an important source of health care in a population with social isolation. These findings may be useful to researchers and policymakers in rethinking health care systems during and after the pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-022-07422-7.

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“… 17 Furthermore, social isolation is also considered to be potentially related to increase in health care utilization. 18 …”

Section: Introductionmentioning

confidence: 99%

The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey

Aoki

Matsushima

2022

J GEN INTERN MED

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“…Finally, even though the final algorithm was automated, the weekly check‐in messages made the platform interactive by allowing patients to request a call back from a provider for bothersome symptoms. Interestingly, only two patients took advantage of this option likely because the weekly messages reduced anxiety and sense of isolation which can prompt patients to seek out healthcare encounters 22,23 . Ultimately, improved provider support encouraged patients to practice self‐management skills and enhanced their sense of self‐efficacy in managing symptoms.…”

Section: Discussionmentioning

confidence: 99%

Development of a patient‐centered text message‐based platform for the self‐management of interstitial cystitis/bladder pain syndrome symptoms

Kim

Brown

Seltzer

et al. 2022

Neurourology and Urodynamics

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Objective: To develop a patient-centered text message-based platform that promotes self-management of symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS).Methods: Adult women with IC/BPS interested in initiating a first-or secondline treatments per American Urological Association guidelines (recategorized as "behavioral/non-pharmacologic treatments" and "oral medicines" in the 2022 version) participated in rapid cycle innovation consisting of iterative cycles of contextual inquiry, prototype design and development. We delivered treatment modules and supportive messages using an algorithm-driven interactive messaging prototype through a HIPAA-compliant texting platform.Patients provided feedback through narrative text messages and an exit interview. Feedback was analyzed qualitatively and used to iteratively revise the platform until engagement ≥ 85% and accuracy ≥ 80% were achieved. The final version consisted of four treatment module categories (patient education and behavioral modification, cognitive behavioral therapy, pelvic floor physical therapy, and guided mindfulness practices) and supportive messages delivered through an automated algorithm over 6 weeks.Results: Thirty IC/BPS patients with moderate symptom bother (median IC Problem Index score 9, range 6−12) participated in five cycles of contextual inquiry. Qualitative analysis identified three overarching concepts that informed the development of the platform: preference for patient centered terms, desire to gain self-efficacy in managing symptoms, and need for provider support. Patients preferred the term "interstitial cystitis" to "bladder pain syndrome" which carried the stigma of chronic pain. Patients reported greater self-efficacy in managing symptoms through improved access to

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“…Another aspect that patients could potentially benefit from those follow-up visits is that appointments can be made for out-clinic consultations as needed. All these services provided during follow-up visits would likely help economically disadvantaged population groups overcome communication barriers, relieve social isolation, and facilitate individuals’ social engagement, thus ultimately achieving improved utilization of health services necessary for residents [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

Jian

et al. 2021

BMC Health Serv Res

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Background Underutilization of health services among chronic non-communicable disease sufferers, especially for hypertension (HBP) and diabetes mellitus (DM), was considered as a significant contributing factor to substantial cases in terms of both avoidable morbidity and mortality. However, evidence on health services underutilization and its associated factors in poverty-stricken areas remain scarce based on previous literature. This study aims to describe health services underutilization for people diagnosed with chronic diseases in impoverished regions and to identify its associated factors, which are expected to provide practical implications for the implementations of interventions tailored to the specific needs of disadvantaged residents in rural China to achieve effective utilization of health services in a timely manner. Methods Data were collected from a cross-sectional survey conducted through face-to-face interviews among 2413 patients from six counties in rural central China in 2019. The Anderson behavioral model was adopted to explore the associated factors. A two-level logistic model was employed to investigate the association strengths reflected by adjusted odds ratios (AOR) and 95% confidence intervals in forest plots. Results On average, 17.58% of the respondents with HBP and 14.87% with DM had experienced health services underutilization during 1 month before the survey. Multilevel logistic regression indicated that predisposing factors (age), enabling factors (income and a regular source of care), and need factors (self-reported health score) were the common predictors of health service underutilization both for hypertensive and diabetic patients in impoverished areas, among which obtaining a regular source of care was found to be relatively determinant as a protective factor for health services underutilization after controlling for other covariates. Conclusions Our results suggested that the implementation of a series of comprehensive strategies should be addressed throughout policy-making procedures to improve the provision of regular source of care as a significant determinant for reducing health services underutilization, thus ultimately achieving equal utilization of health services in impoverished regions, especially among chronic disease patients. Our findings are expected to provide practical implications for other developing countries confronted with similar challenges resulting from underdeveloped healthcare systems and aging population structures.

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Social Isolation Associated with Future Health Care Utilization

Cited by 24 publications

References 29 publications

The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey

The Ecology of Medical Care During the COVID-19 Pandemic in Japan: a Nationwide Survey

Development of a patient‐centered text message‐based platform for the self‐management of interstitial cystitis/bladder pain syndrome symptoms

Health service underutilization and its associated factors for chronic diseases patients in poverty-stricken areas in China: a multilevel analysis

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