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ABSTRACT Background Methods Results Conclusion Healthcare systems need to address the high healthcare use of frail older adults. The Geriatric Services Hub (GSH) is a novel program in Singapore that delivers frailty screening, comprehensive geriatric assessment and coordinated care for community‐dwelling older persons with bio‐psycho‐social needs. We aimed to evaluate the effects of the GSH on healthcare use.We compared healthcare utilization of 634 GSH participants with 634 unique propensity score‐matched non‐GSH community‐dwelling older adults at 12 months before and after GSH enrolment. Baseline matching covariates included demographics, socioeconomic status, disease burden, calendar quarter of enrolment, and past healthcare utilization. We did exact matching on frailty categories (Clinical Frailty Score (CFS) score 4, 5, and 6–7). Difference‐in‐differences technique was used to derive effect estimates.After propensity score matching, baseline covariates were adequately balanced. Healthcare utilization declined in both groups after GSH enrolment. Relative to the comparators and after accounting for pre‐enrolment differences, participation in the GSH was associated with greater primary care (mean difference: 0.06, 95% CI−0.64 to 0.77) and specialist outpatient clinic visits (mean difference: 0.42, 95% CI −0.29 to 1.13), and fewer emergency department visits (mean difference: −0.18, 95% CI −0.69 to 0.34). However, these effects did not reach statistical significance. While number of hospitalizations did not differ between the groups, cumulative length of stay differed by 1.15 bed‐days and was not statistically significant. No statistically significant differences were observed within CFS groups.GSH was not associated with significant reductions in healthcare use in the first year of enrolment. Higher utilization of primary care and specialist outpatient clinic services could reflect the increased identification of care needs with the potential to reduce unnecessary healthcare use such as emergency department visits. Prospective studies with a longer follow‐up would ascertain if the GSH translates to reduced healthcare utilization as hypothesized. [ABSTRACT FROM AUTHOR]

Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36–2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12–3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02–1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups. Methods: Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models. Results: Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only. Conclusion: Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment. Author summary: What is known and unknown: In Australia and Japan, it has been shown that more non-communicable diseases (NCDs) is associated with greater health service use. There is a lack of research in Australia and Japan on how more NCDs is associated with productivity loss, especially involuntary early retirement, absence from work due to chronic illness, and being unemployed despite being in the labour force. There are also limited studies on how the socioeconomic status of individuals in Australia and Japan influences the relationships between multimorbidity with healthcare utilisation and productivity loss. What this study adds: In both Australia and Japan, having more NCDs is associated with higher healthcare utilisation and lower work productivity, including sickness absence, unemployment and early retirement. Across all levels of income and levels of education, there was an association between number of NCDs with healthcare utilisation and work productivity loss. Targeted policies are critical to improve financial protection, especially for lower education groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment [ABSTRACT FROM AUTHOR]

Background: The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs.Methods: Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557).Results: A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina.Conclusion: Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems. [ABSTRACT FROM AUTHOR]

Background: The Ca2+-activated K+ channel KCa3.1 is expressed in several structural and inflammatory airway cell types and is proposed to play an important role in the pathophysiology of asthma. The aim of the current study was to determine whether inhibition of KCa3.1 modifies experimental asthma in sheep. Methodology and Principal Findings: Atopic sheep were administered either 30 mg/kg Senicapoc (ICA-17073), a selective inhibitor of the KCa3.1-channel, or vehicle alone (0.5% methylcellulose) twice daily (orally). Both groups received fortnightly aerosol challenges with house dust mite allergen for fourteen weeks. A separate sheep group received no allergen challenges or drug treatment. In the vehicle-control group, twelve weeks of allergen challenges resulted in a 60±19% increase in resting airway resistance, and this was completely attenuated by treatment with Senicapoc (0.25±12%; n = 10, P = 0.0147). The vehicle-control group had a peak-early phase increase in lung resistance of 82±21%, and this was reduced by 58% with Senicapoc treatment (24±14%; n = 10, P = 0.0288). Senicapoc-treated sheep also demonstrated reduced airway hyperresponsiveness, requiring a significantly higher dose of carbachol to increase resistance by 100% compared to allergen-challenged vehicle-control sheep (20±5 vs. 52±18 breath-units of carbachol; n = 10, P = 0.0340). Senicapoc also significantly reduced eosinophil numbers in bronchoalveolar lavage taken 48 hours post-allergen challenge, and reduced vascular remodelling. Conclusions: These findings suggest that KCa3.1-activity contributes to allergen-induced airway responses, inflammation and vascular remodelling in a sheep model of asthma, and that inhibition of KCa3.1 may be an effective strategy for blocking allergen-induced airway inflammation and hyperresponsiveness in humans. [ABSTRACT FROM AUTHOR]

Introduction: High users of hospital services require targeted healthcare services planning for effective resource allocation due to their high costs. This study aims to segmentize the population in the "Ageing In Place-Community Care Team" (AIP-CCT), a programme for complex patients with high inpatient service use, and examine the association of segment membership and healthcare utilisation and mortality. Methods: We analysed 1,012 patients enrolled between June 2016 and February 2017. To identify patient segments, a cluster analysis was performed based on medical complexity and psychosocial needs. Next, multivariable negative binomial regression was performed using patient segments as the predictor, with healthcare and programme utilisation over the 180-day follow-up as outcomes. Multivariate cox proportional hazard regression was applied to assess the time to first hospital admission and mortality between segments within the 180-day follow-up. All models were adjusted for age, gender, ethnicity, ward class, and baseline healthcare utilisation. Results: Three distinct segments were identified (Segment 1 (n = 236), Segment 2 (n = 331), and Segment 3 (n = 445)). Medical, functional, and psychosocial needs of individuals were significantly different between segments (p-value<0.001). The rates of hospitalisation in Segments 1 (IRR = 1.63, 95%CI:1.3–2.1) and 2 (IRR = 2.11, 95%CI:1.7–2.6) were significantly higher than in Segment 3 on follow-up. Similarly, both Segments 1 (IRR = 1.76, 95%CI:1.6–2.0) and 2 (IRR = 1.25, 95%CI:1.1–1.4) had higher rates of programme utilisation compared to Segment 3. Patients in Segments 1 (HR = 2.48, 95%CI:1.5–4.1) and 2 (HR = 2.25, 95%CI:1.3–3.6) also had higher mortality on follow-up. Conclusions: This study provided a data-based approach to understanding healthcare needs among complex patients with high inpatient services utilisation. Resources and interventions can be tailored according to the differences in needs among segments, to facilitate better allocation. [ABSTRACT FROM AUTHOR]

Chronic disease multimorbidity has become a major challenge for health systems. While a lot of research has evaluated the direct economic burden of multimorbidity on health care utilization and cost, little attention has been given to the impacts on work productivity and functional limitations, as indirect indicators of disease burden. This study aims to examine the prevalence of multimorbidity among Chinese adults and its impact on functional disability and work productivity. It also investigates urban-rural differences in these relationships. This study utilized the data from the China Health and Retirement Longitudinal Study (CHARLS) in 2015, including 11,176 participants aged 45 years and older. Multivariable logistic regression models were used to estimate the effect of multimorbidity on functional disability (i.e. ADL: activities of daily life; IADL: instrumental activities of daily life), and work productivity loss due to health problems. Negative binomial regression models were used to assess the association of multimorbidity with sickness absences from agricultural work and employed non-agricultural work. 68.8% of total participants in CHARLS had multimorbidity in China in 2015. Rural residents with multimorbidity reported higher proportions of physical functions and days of sick leave than urban residents. Multimorbidity was positively associated with ADL limitation (odds ratio 1.924, 95% CI 1.656–2.236), IADL limitation (1.522, 1.326–1.748), limited work due to health problems (1.868, 1.601–2.178) and days of sick leave (for agricultural work, incidence rate ratio 1.676, 95% CI 1.390–2.020; for employed non-agricultural work, 2.418, 1.245–4.696). For the rural group, the impact of multimorbidity on functional limitations and work productivity loss (except for early retirement), was less than the urban group. Multimorbidity poses significant challenges for functional health and work productivity These have significant negative economic consequences for individuals, the Chinese health system and the society. [ABSTRACT FROM AUTHOR]

Introduction Patient-Centered Medical Home (PCMH) aims to improve care quality with a shift from the traditional biomedical model to one that emphasizes patient experience and preferences. Community for Successful Ageing (ComSA)-PCMH is the first community-based PCMH model for complex adults consisting of center-based primary care clinic and home-based care management as an integrated multidisciplinary care-team. This study aimed to understand patients' care experience in ComSA-PCMH. Methods A semi-structured topic guide was developed and adapted from the PCMH principles, to generate data on care experience. Qualitative data consisted of six focus group discussions with patients/primary caregivers enrolled in the program for at least six months. Framework analysis was used with both deductive and inductive approaches in coding. Results Majority of participants identified ComSA-PCMH as a 'specialized' primary care model targeting only older adults with complex care and reported qualitative benefits in consolidated appointments, integrated medical and social care, and subjective health-related improvement. Participants valued the sustained patient-provider relationship, communication, and care personalization in ComSAPCMH. They appreciated the relationship-based care, emphasizing on the high value to be treated holistically as a person, rather than a disease. Better continuity of care was experienced by having access to the same provider for their health journey, enabling them to have better perceived familiarity and trust while communicating their needs. These were supported by the sufficient time given during the consultation, perceived to be one of the key differentiating factor for ComSAPCMH from their previous provider. They also appreciated the involvement of family members/caregivers in care planning. Other aspects of care delivery, i.e. team-based care and care coordination were not as clearly expressed. Participants were unable to identify home-care management as part of their care-team, even for those receiving the services. In addition, experiences in care coordination across different healthcare provider were not shared much. However, participants perceived an "inherent" integration as evidenced from the linked medical record. Discussions Studies on patient-centeredness reported similar findings on participants who value patientprovider relationship and communication. In this study, characterization and understanding of this new care model was driven primarily by participant's previous experience of Singapore's current healthcare system. Perception on team-based care and care coordination was lacking. The experiences may not be realized by participants due to the lack of understanding of the new care model. Conclusions Participants were able to identify ComSA-PCMH as a new care model with better experiences in patient-provider relationship and communication. Perception in the domains of patientcenteredness may change with increasing awareness and longer experience with this type of care. Lessons learned Improved understanding and effective communication on components and functions of the new care model amongst patients and caregivers are important, as they would likely influence the perceived experiences of the intended care model. Limitations The FGDs may be limited to patients with less complex care needs. Suggestions Future research may sample participants with different biopsychosocial complexities, to fully capture the differing care experiences. Subsequent IDIs for different typology could give more understanding in context and mechanism of care experiences. [ABSTRACT FROM AUTHOR]

Introduction Patients with complex needs require greater biopsychosocial support. Fragmented services often result in gaps, duplication or incompatibility in treatments, leading to poorer health outcomes and higher utilization of costly hospital-based healthcare services. Patient-Centred Medical Home (PCMH) is a primary care model reform, often advocated for patients with complex needs because of its emphasis on comprehensiveness, coordinated care, patient-centeredness, accessible services, quality and safety. Community for Successful Ageing (ComSA)-PCMH, launched on November 2016, is the first PCMH in Singapore. It serves older adults with complex needs within a geographical precinct, delivering care integrated: 1) between its primary care clinic and homebased care management; 2) vertically with an acute hospital; and 3) horizontally with other community-based services. This study aimed to assess the impact of ComSA-PCMH on their patients' healthcare utilization. Theory/Methods This study used a difference-in-difference approach to compare quarterly healthcare utilization of 165 ComSA-PCMH participants (enrolled between Oct'2017 and Apr'2019) against 10,939 controls from a neighbouring geographical precinct selected using Coarsened Exact Matching. Healthcare utilization data spanning Oct'2014 to Mar'2020, which includes other primary care, specialist outpatient clinic (SOC) and emergency department (ED) utilization, and inpatient hospital admissions, were extracted from a regional health system database. Two-part models were fitted, consisting of logistic regression to assess the binary outcome of having any utilization per calendar quarter (Part 1), followed by Poisson regression to assess number of utilization events amongst those with any utilization per calendar quarter (Part 2). All regressions controlled for sociodemographics, weighted Charlson Comorbidity Index, secular trends including effect of COVID-19, and between-group differences. Statistical inferences were based on cluster-robust standard errors at the individual level. Results ComSA-PCMH participants had 0.74 fewer quarterly visits to other primary care in the calendar quarter after enrolment (p<0.001), and 1.08 fewer quarterly visits to other primary care four or more quarters after enrolment (p<0.001). PCMH study participants also had 0.37 fewer quarterly SOC visits (p=0.047), 0.04 fewer quarterly ED visits (p=0.013) and 0.02 fewer quarterly inpatient hospital admissions (p=0.093) four or more quarters after enrolment. Discussion Post-enrolment reductions in healthcare utilization were observed. A one-year lag occurred before significant reductions in hospital-based healthcare utilization, possibly due to time needed for developing patient-provider relationship and trust. Conclusions The study found that ComSA-PCMH participants had reduced healthcare utilization after enrolment into the programme, adding to a growing body of evidence supporting the benefits of PCMHs on care consolidation and patient-centred approach. Lessons learnt PCMH shows potential in reducing costly hospital-based healthcare utilization after a year. Limitations Pre-enrolment healthcare utilization trajectories of participants and controls were not parallel due to difficulties identifying counterfactuals with similar complex needs. Thus, casual inference of estimates should be interpreted with some caution. Nonetheless, comparisons with pre-enrolment trends suggest that post-enrolment reductions in hospital-based healthcare utilisation were attributable to ComSA-PCMH. Suggestions for future research Long-term impact of PCMH on healthcare utilization could be better assessed with a longer followup period. [ABSTRACT FROM AUTHOR]