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Research that identifies the determinants of low mammography use among disabled people is scant. This study examines the determining factors related to the low usage of mammography among women with disabilities. To identify the barriers that prevent women with disabilities from participating in mammography screening can help authorities conceive feasibly useful strategies for avoiding worse suffering. With women aged between 50 and 69 as subjects, this study was conducted using the database of Ministry of the Interior, Taiwan, in 2008, coupled with information gathered between 2006 and 2008 on preventive health care and medical claim data from the Bureau of Health Promotion and the National Health Research Institutes, respectively. This study examined the factors determining the use of mammography with logistic regression analysis. Only 8.49% of the disabled women used mammographies. When women with disabilities were in higher income level, they were more likely to use mammography for breast cancer screening. Similar findings were found for education levels. Moreover, subjects with a more severe form of disability were less likely to use mammography with ORs of 0.84, 0.63, and 0.52. Disabled women with major organ malfunction, chronic mental illness, or mental retardation had a higher likelihood to use mammography services, whereas women with multiple disabilities had the lowest likelihood of usage. Those with experience using other preventive services showed 1.9 times to 7.54 times (95% CI: 1.82-1.98, 7.15-7.95, respectively) increased likelihood of mammography usage. In summary, mammography usage is relatively different for disabled and nondisabled populations. To mitigate the disparities, we can use community healthcare institutions or public health nurses and social workers to provide related preventive health services through community events to implement integrated cancer screening services. (Contains 3 tables.)

Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED) visits among type 2 diabetic patients receiving care under a diabetes disease management (DM) program offered by the Louisiana State University Health Care Services Division (LSU HCSD). Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM) Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c) levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI), gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further research to understand inappropriate ED use among insured patients is needed. We suggest providing visit reminders, a call centre, or case managers to reduce the likelihood of less-urgent ED visit use among DM patients. By reducing the likelihood of unnecessary ED visits, successful DM programs can improve patient care.

Aims/Introduction: This study investigated whether participation by patients with type 2 diabetes in Taiwan's pay‐for‐performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy. Materials and Methods: The analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time‐dependent (time‐varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates. Results: Despite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398–0.898, P = 0.012), 0.676 (95% CI 0.520–0.867, P = 0.0026) and 0.802 (95% CI 0.603–1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not. Conclusions: Diabetes care requires a long‐term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients' lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy. [ABSTRACT FROM AUTHOR]

Several factors, including healthcare outcomes and quality, influence patients' expectations of healthcare services. Currently, as patients have more understanding about dental care services, patient satisfaction is essential for continually improving the services being provided. The purpose of this study is to analyze the multiyear annual National Health Insurance (NHI) patient experience survey in Taiwan to explore the factors associated with the satisfaction rate from 2012–2016. This study used the annual NHI survey to explore patients' experiences of receiving medical service in dental care from 2012 to 2016. There were over 40 major items in the survey each year; however, we only selected suitable items that followed the Andersen model. We ran a logistics regression testing the relationship between the covariates and the items related to satisfaction in outcomes in different years. Patients who received health education from a provider in most time, self-reported better health status, felt that cost of care was not expensive, did not wait too long for counseling time and found it easy to make an appointment, had two to ten times greater satisfaction in outcomes compared with those who did not (OR: 1.83–10.06). Individuals working in the healthcare industry should implement communication strategies to improve patients' experience in the care process by including easy-to-understand explanations or sharing decision-making with patients. Furthermore, in patient experience surveys in dental care, less attention should be paid to whether patients can provide meaningful quality measures and more attention to ways in which patient experiences can be improved. This can be achieved by providing easy-to-understand explanations, giving patients an opportunity to express their concerns, and by sharing decision-making with patients [ABSTRACT FROM AUTHOR]

Numerous antinuclear demonstrations reveal that the public is anxious about the potential health effects caused by nuclear power plants. The purpose of this study is to address the question 'Is there a higher cancer incidence rate in the vicinity of nuclear power plants in Taiwan?' The Taiwan Cancer Registry database from 1979 to 2003 was used to compare the standardized incidence rate of the top four cancers with strong evidence for radiation risks between the 'plant-vicinity' with those 'non-plant-vicinity' groups. All cancer sites, five-leading cancers in Taiwan, and gender-specific cancers were also studied. We also adopted different observation time to compare the incidence rate of cancers between two groups to explore the impact of the observation period. The incidences of leukemia, thyroid, lung, and breast cancer were not significantly different between two groups, but cervix uteri cancer showed higher incidence rates in the plant-vicinity group. The incidence of cervical cancer was not consistently associated with the duration of plant operation, according to a multiyear period comparison. Although there was higher incidence in cervix cancer in the plant-vicinity group, our findings did not provide the crucial evidence that nuclear power plants were the causal factor for some cancers with strong evidence for radiation risks. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the appropriateness of the definition of outpatient-shopping behavior in Taiwanese patients., Study Design: Linked study of 3 databases (Taiwan Cancer Registry, National Health Insurance [NHI] claim database, and death registry database)., Methods: Outpatient shopping behavior was defined as making at least 4 or 5 physician visits to confirm a cancer diagnosis. We analyzed patient-related factors and the 5-year overall survival rate of the outpatient-shopping group compared with a nonshopping group. Using the household registration database and NHI database, we determined the proportion of outpatient shopping, characteristics of patients who did and did not shop for outpatient therapy, time between diagnosis and start of regular treatment, and medical service utilization in the shopping versus the nonshopping group., Results: Patients with higher incomes were significantly more likely to shop for outpatient care. Patients with higher comorbidity scores were 1.4 times more likely to shop for outpatient care than patients with lower scores. Patients diagnosed with more advanced cancer were more likely to shop than those who were not. Patients might be more trusting of cancer diagnoses given at higher-level hospitals. The nonshopping groups had a longer duration of survival over 5 years., Conclusions: Health authorities should consider charging additional fees after a specific outpatient- shopping threshold is reached to reduce this behavior. The government may need to reassess the function of the medical sources network by shrinking it from the original 4 levels to 2 levels, or by enhancing the referral function among different hospital levels.