Health resource use in epilepsy: Significant disparities by age, gender, and aboriginal status

Abstract

SUMMARYPurpose: Epilepsy imposes a significant burden on society. The objective of this study was to estimate health resource utilization (HRU) over a 1-year period in epilepsy patients, using administrative databases. Methods: Three administrative databases (inpatient, emergency, and physician claims) were used to identify epilepsy cases. HRU variables included general physician (GP) and emergency (ER) visits, physician billings, hospitalizations, and length of stay (LOS). Logistic regression was used to determine the association between demographic variables and HRU variations. Results: Among the 1,431 patients with a mean age of 37.5 ± 17.3 years, 56 (4%) were aboriginal. Ninety-six percent of patients saw a GP or a specialist (outpatient visit), 12% were hospitalized, and 8% visited the ER. Younger patients were more likely to see a neurologist (OR = 1.7, 95% CI 1.3-2.3), visit the ER (OR = 4.9, 95% CI 3.2-7.4), or be hospitalized (OR = 2.9, 95% CI 2.0-4.3). Females were less likely to see a GP but more likely to see a neurologist. Aboriginals were more likely than nonaboriginals to visit the ER (OR = 2.3, 95% CI 1.1-5.0) or be hospitalized (OR = 2.8, 95% CI 1.5-5.1) but less likely to see a neurologist (OR = 0.3, 95% CI 0.2-0.6). Welfare status and residence location (urban vs. rural) were not associated with HRU level. Discussion: We demonstrated the feasibility of using administrative databases to assess HRU in epilepsy. We also uncovered disparities in HRU by age, gender, and by aboriginal status, suggesting possible internal or external barriers to specialized care in some groups.

Quality of Care for First Nations and Non-First Nations People with Diabetes

“…First Nations People in general experience decreased access to both primary generalist care and specialist care, compared with similar geographic and socioeconomic populations (13). Decreased access to specialist care for First Nations People has also been shown in patients with epilepsy and CKD (14,15). However, to our knowledge, our study is the first to correlate disparities in care to clinical outcomes, and to show that such differences vary with the presence of comorbidity such as CKD.…”

“…Previous studies suggest First Nations People experience disparities in health care compared with the general population (13,14), including among patients with CKD (15). Although the increased prevalence of diabetes among First Nations People may contribute to their increased rates of ESRD, it is unknown whether the care they receive also plays a role.…”

The direct medical costs of epilepsy in children and young people: A population-based study of health resource utilisation

“…Very similar findings regarding age groups were reported when the costs of hospital care were estimated for 3,892 people (mostly adults) with epilepsy resident in Wales, UK (Morgan and Kerr 2004). A Canadian study of 1,431 patients with epilepsy reporting health resource utilisation (HRU) over 1 year but not the associated costs, also suggested that CYP with epilepsy under 18 years of age were more likely than adults to see neurologists, visit emergency departments and be admitted to hospital (Jette et al, 2008).…”

“…Studies of health resource utilisation (HRU) in regions of Canada and Wales have indicated that CYP under 18 years of age are more likely than adults to see neurologists, visit emergency departments, and have more inpatient and outpatient hospital admissions (Jette et al, 2008;Morgan et al, 2000). Studies in these populations, consisting mainly of adults, also showed HRU differences by sociodemographic factors, such as increased hospital care utilisation for epilepsy in those with higher socioeconomic deprivation in Wales (Jette et al, 2008;Morgan et al, 2000). These studies, however, did not assess relationships specifically in CYP nor did they estimate any associated costs, which are required to inform service configuration and evaluation for CYP.…”

Association between First Nations ethnicity and progression to kidney failure by presence and severity of albuminuria

“…26,27 Reduced access to specialist care for First Nations people with epilepsy has also been reported. 28 Not all of the participants in our study had albuminuria measurements, with nonmeasurement more common among First Nations participants. This may represent an opportunity to improve care, because measurement of albuminuria is an indicator of overall access to care for chronic kidney disease.…”