Unregulated access to health-care services is associated with overutilization--lessons from Austria

Pichlhöfer, Otto; Maier, Martin

doi:10.1093/eurpub/cku189

Cited by 20 publications

(14 citation statements)

References 9 publications

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“…A high level of awareness of the risks of hypertension among the Austrian population has been demonstrated, although this appears to have waned recently. 17,18 Another factor could be the unregulated access to all levels of health care and 19 The Austrian acute stroke service is also efficient with fast admissions, good availability of investigation modalities, and few delays. 20 Conversely, Bulgaria has the highest CVD mortality for both sexes, but relatively low IHD mortality, possibly related to the prevalence of heavy alcohol use in the country.…”

Section: Discussionmentioning

confidence: 99%

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

et al. 2016

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Background— Trends in cardiovascular mortality across Europe demonstrate significant geographical variation, and an understanding of these trends has a central role in global public health. Methods and Results— Ischemic heart disease and cerebrovascular disease age-standardized death rates (as per International Classification of Diseases , ninth and tenth revisions) were collated from the World Health Organization mortality database for member states of the European Union. Trends were characterized by using Joinpoint regression analysis. An overall trend for reduction in ischemic heart disease mortality was observed, most pronounced in Western Europe (>60% for the Netherlands, United Kingdom, and Ireland) for both sexes from 1980 to 2009. Eastern European states, Romania, Croatia, and Slovakia, had modest mortality reductions. Most recently (2009), Lithuania had the highest mortality for males and females (318.1/100 000 and 166.1/100 000, respectively), followed by Latvia and Slovakia. France had the lowest mortality: 39.8/100 000 for males and 14.7/100 000 for females. Analysis of cerebrovascular disease mortality revealed that Austria had the largest reduction for both sexes (76.8% males, 76.5% females) from 1980 to 2009. The smallest improvement over this period was seen in Lithuania, Poland, and Cyprus (–5% to +20% approximately). France has the lowest present-day cerebrovascular disease mortality for both males and females (23.9/100 000 and 17.3/100 000, respectively). Conclusions— There is a growing disparity in cardiovascular mortality between Western and Eastern Europe, for which diverse explanations are discussed. The need for population-wide health promotion and primary prevention policies is emphasized.

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Section: Discussionmentioning

confidence: 99%

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

et al. 2016

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“…One of the explicit ideas is that this will result in reduced demand for specialised care, since health clinicians are better informed than patients to make the right referrals. 13 However, the use of patient self-referral and internet-delivered treatment programmes are recent developments that may improve treatment access and reduce barriers for patients with severe health anxiety. 14 These innovative programmes consist of highly structured online modules with homework assignments and communication with a clinician via email, telephone or an embedded online forum.…”

Section: The Potential Role Of Self-referralmentioning

confidence: 99%

Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment

et al. 2019

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Background Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. Aims This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. Method Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. Results In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. Conclusions Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. Declaration of interest None.

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“…Unfortunately, the study design and questionnaire does not allow such analyses. However, it could be speculated that at least some part of the consultations at specialists were due these patient perceptions, as Austria is a secondary care focused country, and the overall utilization of the second level of health care is quite high [ 36 , 45 ]. In this case it could be of benefit for patients to be guided through the complex health care system with the support of a primary care provider, preferentially through structural incentives or a gatekeeping system.…”

Section: Discussionmentioning

confidence: 99%

Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria

et al. 2015

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The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, with data from 15,474 individuals. Statistical methods used were descriptive tests, regression models and the calculation of synergistic effects. Both chronic back pain and psychological distress had a positive association with the utilization of the primary (OR for chronic back pain 1.53 and psychological distress 1.33) and secondary (OR for chronic back pain 1.32 and psychological distress 1.24) levels of the health care sector. In the fully adjusted model, the synergistic effect of chronic back pain and psychological distress was significant for the secondary level of care (S 1.99, PAF 0.20), but not for the primary level of care (S 1.16, PAF 0.07). Synergistic effects and associations for chronic back pain and psychological distress on the utilization of both the primary and secondary levels of the ambulatory health care sector were observed, particularly for the secondary level of care. Our results demonstrate the utilization of health care services settings by individuals with these conditions, and offer opportunities to consider reorganization and structuring of the Austrian health care system.

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Unregulated access to health-care services is associated with overutilization--lessons from Austria

Cited by 20 publications

References 9 publications

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe

Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment

Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria

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