Suchergebnisse

ABSTRACT
IntroductionThe prevalence of depression is 2 to 3 times higher in individuals with comorbid medical condition (CMC) than in the general population. When untreated, depression results in increased mortality, higher health care costs, greater functional disability, decreased quality of life and lower adherence to treatment regimens for the CMC. Currently, studies that examined whether depression care in those with CMC is better or worse compared to those with depression alone show inconsistent results. Furthermore, studies that compare depression care in those with specific CMCs are scarce. Improving knowledge base in this area will enable health care systems to better allocate limited resources to clinical population that need them most.
Aims1) To estimate disparities in depression care in those with one or more CMCs, and 2) to examine if depression care patterns in those with CMCs have been impacted by recent provincial policies.
MethodWe retrospectively examined data from physician claims, hospital separations, vital statistics, and insurance plan registries. Using this linked data, we identified dynamic cohorts of individuals with depression and CMCs in 2005 and 2012, based on the earliest date of depression diagnosis. Each cohort had exactly 12 months of lookback period for case ascertainment and 12 months of follow-up for tracking depression care patterns. The following indicators were tracked: 1) receipt of any psychological therapy, 2) receipt of any antidepressants (AD), 3) receipt of any depression treatment, 4) number of GP visits, 5) GP continuity of care index for all visits, 6) GP continuity of care for mental health visits, 6) counts of psychological therapy sessions, 7) proportion of days covered for AD, and 8) continuous medication gap for AD. Disparities in depression care were examined used generalized linear regression models.
Results and ConclusionsUse of depression care in individuals with one or more CMC were higher across most indicators we examined except for AD initiation and GP visits for mental health reasons. In specific CMCs like cerebrovascular disease and diabetes, depression care in some areas were lower. Overall, depression care patterns seemed unchanged after the introduction of relevant provincial policies, although improvements over time appeared to have been made in certain areas.

Open‐ended interviews were conducted with 109 individuals. These included: administrators, staff, dental personnel, residents, and family members, associated with 12 long‐term‐care (LTC) facilities to contrast different human resource and organizational strategies for managing the delivery of oral health care to the elderly residents. A multiple case‐study analysis revealed that no particular organizational strategy was ideal, although three important components—oral hygiene, diagnostic assessments, and dental treatment—were common to all. The dental personnel everywhere believed that oral health in the midst of other conflicting priorities received inadequate attention, while the administrators and staff acknowledged that they were weak at recognizing oral disorders and assisting with oral hygiene. In all, the interviews offered a portrait of the conflicting priorities associated with LTC, and they provide practical insights to successful strategies of care in this population.

Health care utilization by the elderly has increased during recent times. However, a number of investigators have indicated that this increase has had less to do with increasing numbers of elders than with increasing age-specific utilization rates for a variety of health services. 1985 and 1993 health data for British Columbia were used to examine changes in outpatient surgical utilization among the general population and changes in cataract surgical utilization among the elderly. Utilization increases in the older persons exceeded what would be expected on the basis of population increase. Furthermore, cataract surgery alone accounted for more than 29 percent of the entire utilization increase observed for outpatient surgery. Despite this increase, the average age at cataract surgery has not changed—seniors of all ages are much more likely to receive cataract surgery now than a decade ago. The authors' findings suggest that a part of this observed increase is due to operating on individuals at preoperative levels of better visual function.