Previous research has found that certain factors can influence use of health care services. For example, studies from the US have found increased ED visits to be linked with loneliness,
vulnerability and lack of access to family support in older people (Lowthian et al., 2011). The quality of social interactions has been found to affect health and health-related behaviour. Negative feelings or dysfunction between members in social networks can increase stress and affect a person’s overall sense of well-being, increasing use of GP services and readmission to hospital. On the other hand, positive social support may have a ‘buffering’ affect that mitigates the effect of life stresses, contributing to good health. Furthermore, social networks may directly affect health through provision of information about health services, encouraging health service use and supporting healthy behaviours (Mistry et al., 2001).
Other factors that may affect use of services include finances and proximity to services. Research has found that low household income is a barrier to using healthcare services (Blackwell, Martinez, Gentleman, Sanmartin, & Berthelot, 2009; Gong, Kendig, & He, 2016; National Health Performance Authority, 2015). A study from South Korea using a nationwide longitudinal study found that the
level of health insurance held affected length of time spent in hospitals, with less coverage resulting in lower healthcare utilisation (Kim & Lee, 2016). Living in an urban area significantly increases the likelihood of people contacting a GP (Babitsch, Gohl, & von Lengerke, 2012).
The paper below uses the Andersen-Newman model to examine factors that can influence health service use in people with different levels of cognitive functioning (normal, MCD and
dementia). This model posits that there are individual characteristics, divided into three factors, that contribute to the type and volume of health service a person uses (Andersen & Newman, 1973). The three factors are: 1) predisposing, 2) enabling, and 3) need. These factors are described in more detail in Chapter 2.
The Andersen-Newman model has been extensively used in studies which examine use of health services (Babitsch et al., 2012). A number of these studies have examined use in the elderly
population (Korten et al., 1998; Parslow et al., 2004) and use by people with dementia (Forbes, Morgan, & Janzen, 2006; Toseland et al., 2002). However, very few studies examine use across the continuum of cognitive, from normal cognition dementia. The aim of this paper is to examine predictors of usage in individuals with MCI or dementia compared to those who are cognitively healthy.
Statement of authorship
Predictors of healthcare service use: a cross-sectional study examining use in participants across the cognitive continuum. Prepared for submission.
Lily O’Donoughue Jenkins (PhD candidate)
Developed study concept and design; initiated data linkage process with CHeReL; submitted ethics approval and project proposal for linkage of ACT Admitted Patient Care data and PATH data to CHeReL; prepared spreadsheet with hospital data provided by CHeReL, health and
sociodemographic variables extracted from PATH; analysed and interpreted data; drafted and edited the manuscript; acted as corresponding author. I certify that the statement of contribution is
accurate
Signed……… Date……….
Kaarin J. Anstey (Principal supervisor)
Assisted in developing the study concept and design; drafted and provided critical revision of the article; assisted in interpretation of data analysis; provided final approval of the manuscript to be published. I certify that this statement of contribution is accurate and permission is given for Lily O’Donoughue Jenkins to include this paper in this thesis for examination towards the Doctor of Philosophy
Signed……… Date……….
7.3 Summary
Paper 5 examined the different factors which could contribute to use of healthcare services, based on the Andersen-Newman model. It found that dementia increased the number of overnight hospital admissions and the length of hospital stay. MCD increased the number of same day admissions but decreased the length of hospital stay. Different factors contributed to usage of hospital services (ED presentation, same day and overnight admissions) depending on whether individuals were cognitively healthy, had MCD or dementia. For example, physical health was significantly associated with all three hospital services in cognitively healthy individuals. However, physical health was only associated with ED use for dementia participants. Predisposing and need variables explained the majority of each individual’s use, with health insurance only significant for use of overnight hospital admissions by dementia participants.
Studies which have examined the impact of cognition on healthcare service use have examined people with dementia (Forbes et al., 2006; Toseland et al., 2002), used nursing homes residents for their sample (LaMantia et al., 2016; Stephens et al., 2014) or had methodological flaws. For example, a number of studies have only used the MMSE, or an adaptation of it, rather than a
neuropsychological assessment (Korten et al., 1998; Redondo-Sendino, Guallar-Castillón, Banegas, & Rodríguez-Artalejo, 2006; St-Hilaire et al., 2017; Zimmer et al., 2001). Although the MMSE is used for screening for cognitive impairment it is not sensitive to subtle cognitive decline (St-Hilaire et al., 2017). However, it is important to examine people with MCI/MCD as they are at a higher risk of remaining cognitively impaired or progressing to dementia.
Gaining an understanding of the reasons why older adults use health care services and
opportunities for interventions is essential for planning informed strategies to meet the health care needs of an ageing population (Gruneir, Silver, & Rochon, 2011). For example, in this paper positive family support was shown to decrease same day admissions in dementia participants. This
association may be due to family members providing services or care which decreases the risk of 179
individuals being hospitalised. Providing support to an individual with dementia can be burdensome and carers may use more health services as a result (Bremer et al., 2015). Therefore, to sustain positive support, future programs and policies need to provide support services for these family members.
Another example relates to affordability of services. Not having health insurance and being on a pension-only income decreased visits to a GP. However, neither of these variables was associated with ED presentations. Instead of going to a GP, a fee-paying service which may result in follow-up consultations, individuals may go to an ED, thereby increasing ED presentations. Ensuring that access to primary health care is affordable, especially for individuals with a cognitive impairment, is
important now and in the future.
This chapter has discussed the different factors associated with GP visits, ED presentations, overnight and same day hospital admissions and length of hospital stay and how these differ for individuals with Dementia, MCD or those who are cognitively healthy. The next chapter will discuss the policy implications of healthcare service research, including primary, secondary and tertiary prevention.