Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting
2.2. Design
2.3. Mapping Segregated Roma Settlements
2.4. Roma Settlement Specific Version of NIHIFM’ Routine Primary Adult Care Indicators
2.5. Statistical Analysis
2.6. Ethics Approval and Consent to Participate
2.7. Availability of Data and Material
3. Results
3.1. Pathway Indicators
3.2. Performance Indicators
3.3. All-Cause Premature Mortality
4. Discussion
4.1. New Indicator Set for Segregated Roma Settlements
4.2. Main Findings and Concordance with Others’ Observations
4.3. Strengths and Limitations
4.4. Implications
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Indicator Type | Indicator Name |
---|---|
pathway indicators | number of GP appointments per person per year |
proportion of subjects receiving outpatient care per year | |
number of interventions in outpatient care per person per year | |
reimbursement for interventions in outpatient care per person per year | |
proportion of subjects hospitalized per year | |
duration of hospitalization in inpatient care per person per year | |
reimbursement for inpatient care per person per year | |
proportion of subjects having an imaging examination per year | |
total number of imaging examinations per person per year | |
reimbursement for imaging examination in outpatient care per person per year | |
performance indicators | proportion of patients above 65 years of age vaccinated against influenza within the last 12 months |
proportion of patients aged 40–54 years with treated hypertension (taking antihypertensive medication at least four times within 12 months) | |
proportion of patients aged 55–69 years with treated hypertension (taking antihypertensive medication at least four times within 12 months) | |
proportion of patients having a serum creatinine test within the last 12 months among treated hypertensive patients (taking antihypertensive drugs at least four times within the last 12 months) | |
proportion of patients having a lipid status assessment within the last 12 months among treated hypertensive and/or treated diabetes patients (taking antihypertensive medication at least four times within 12 months and/or taking ATC code A10 drugs at least four times within the last 12 months) | |
proportion of patients taking beta-blocker medication at least four times within 12 months relative to the total number of acute myocardial infarction (MI) and/or coronary artery bypass surgery (CABG) and/or percutaneous coronary intervention (PTCA) patients | |
proportion of patients among treated diabetes patients having a hemoglobin A1c test within the last 12 months (taking ATC code A10 drugs at least four times within the last 12 months) | |
proportion of patients among treated diabetes patients examined by ophthalmologist within the last 12 months (taking ATC code A10 drugs at least four times within the last 12 months) | |
proportion of patients aged 40–54 years with treated diabetes mellitus (taking ATC code A10 drugs at least four times within 12 months) | |
proportion of patients aged 55–69 years with treated diabetes mellitus (taking ATC code A10 drugs at least four times within 12 months) | |
per capita amount of purchased antibiotics prescribed by the GP, in the previous 12 months | |
participation rate of mammography in the previous 24 months among 45- to 65-year-old women | |
participation rate of cervical cytology in the previous 36 months among 25- to 65-year-old women | |
all-cause premature mortality | mortality rate for adults 18–64 years old who had not changed GMPs in the five years prior to the investigated year |
Indicators | Crude Rates in the Sample, N (%) | SRS | Non-SRS | RR [95% CI] | ||
---|---|---|---|---|---|---|
N | Standardized Rates [95% CI] | N | Standardized Rates [95% CI] | |||
number of GP appointments (appointments per capita per year) | 454,257 (8.31) | 22,322 | 1.144 [1.129–1.159] | 431,935 | 0.994 [0.991–0.996] | 1.152 [1.136–1.167] |
number of subjects receiving outpatient care at least once a year (%) | 40,255 (73.62) | 2059 | 0.97 [0.929–1.012] | 38,196 | 1.002 [0.992–1.012] | 0.968 [0.926–1.012] |
number of interventions in outpatient care a year (interventions per capita) | 1,834,015 (33.54) | 76,715 | 0.897 [0.891–0.904] | 1,757,300 | 1.005 [1.004–1.007] | 0.893 [0.886–0.899] |
reimbursement in outpatient care a year (EURO per capita) | 2,011,662 (36.79) | 87,311 | 0.924 [0.918–0.930] | 1,924,351 | 1.004 [1.002–1.005] | 0.920 [0.914–0.927] |
number of subjects having imaging examination at least once a year (%) | 28,629 (52.36) | 1556 | 1.061 [1.009–1.115] | 27,073 | 0.997 [0.985–1.009] | 1.064 [1.011–1.120] |
number of imaging examinations a year (examinations per capita) | 1,076,117 (19.68) | 44,413 | 0.899 [0.891–0.908] | 1,031,704 | 1.005 [1.003–1.007] | 0.895 [0.887–0.904] |
reimbursement for imaging examination a year (EURO per capita) | 703,974 (12.87) | 34,139 | 1.034 [1.023–1.046] | 669,835 | 0.998 [0.996–1.001] | 1.036 [1.025–1.047] |
number of subjects being hospitalized at least once a year (%) | 9007 (16.47) | 522 | 1.269 [1.165–1.383] | 8,485 | 0.987 [0.966–1.008] | 1.286 [1.177–1.405] |
duration of hospitalization a year (days per capita) | 142,475 (2.61) | 58,265 | 1.162 [1.132–1.192] | 136,649 | 0.994 [0.989–0.999] | 1.168 [1.138–1.200] |
reimbursement in inpatient care a year (EURO per capita) | 7,554,882 (138.16) | 299,580 | 1.058 [1.054–1.061] | 7,255,301 | 0.9977 [0.9970–0.9984] | 1.060 [1.057–1.064] |
Indicators | Crude Rates in the Sample, N (%) | SRS | Non-SRS | RR [95% CI] | ||
---|---|---|---|---|---|---|
N | Standardized Rates [95% CI] | N | Standardized Rates [95% CI] | |||
influenza vaccination, above 65 years of age | 2523 (23.22) | 29 | 0.679 [0.472–0.977] | 2494 | 1.006 [0.967–1.046] | 0.675 [0.468–0.973] |
prevalence of hypertension, 40–54 years | 3461 (25.57) | 200 | 0.999 [0.870–1.148] | 3261 | 1.000 [0.966–1.035] | 0.999 [0.866–1.153] |
prevalence of hypertension, 55–69 years | 6938 (55.99) | 200 | 0.916 [0.798–1.053] | 6738 | 1.003 [0.979–1.027] | 0.914 [0.794–1.052] |
Serum-creatinine assessment, hypertension | 10447 (60.99) | 309 | 0.964 [0.863–1.078] | 10,138 | 1.001 [0.982–1.021] | 0.963 [0.860–1.079] |
lipid status check-up, hypertension and/or diabetes | 9666 (54.73) | 324 | 1.067 [0.957–1.189] | 9342 | 0.998 [0.978–1.018] | 1.069 [0.957–1.194] |
beta–blocker, ischemic heart diseases | 523 (51.73) | 23 | 1.049 [0.697–1.579] | 500 | 0.998 [0.914–1.089] | 1.052 [0.692–1.597] |
HbA1c check-up, diabetes | 2674 (73.64) | 82 | 0.817 [0.658–1.015] | 2592 | 1.007 [0.969–1.047] | 0.811 [0.651–1.011] |
ophthalmologic check-up, diabetes | 1313 (36.16) | 34 | 0.701 [0.501–0.982] | 1279 | 1.011 [0.958–1.068] | 0.693 [0.493–0.975] |
prevalence of diabetes, 40–54 years | 618 (4.57) | 40 | 1.123 [0.824–1.531] | 578 | 0.992 [0.915–1.077] | 1.132 [0.821–1.559] |
prevalence of diabetes, 55–69 years | 1241 (10.01) | 36 | 0.929 [0.670–1.287] | 1205 | 1.002 [0.947–1.061] | 0.927 [0.665–1.291] |
treatment with antibiotics | 13371 (24.49) | 570 | 0.791 [0.728–0.858] | 12,801 | 1.012 [0.995–1.030] | 0.781 [0.718–0.850] |
mammography, 45–64 years | 4451 (47.96) | 76 | 0.392 [0.313–0.490] | 4375 | 1.028 [0.998–1.059] | 0.381 [0.304–0.478] |
cervix cytology, 25–64 years | 7365 (40.22) | 428 | 0.959 [0.873–1.055] | 6937 | 1.003 [0.979–1.027] | 0.957 [0.868–1.055] |
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Sándor, J.; Pálinkás, A.; Vincze, F.; Kovács, N.; Sipos, V.; Kőrösi, L.; Falusi, Z.; Pál, L.; Fürjes, G.; Papp, M.; et al. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. Int. J. Environ. Res. Public Health 2018, 15, 1835. https://doi.org/10.3390/ijerph15091835
Sándor J, Pálinkás A, Vincze F, Kovács N, Sipos V, Kőrösi L, Falusi Z, Pál L, Fürjes G, Papp M, et al. Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study. International Journal of Environmental Research and Public Health. 2018; 15(9):1835. https://doi.org/10.3390/ijerph15091835
Chicago/Turabian StyleSándor, János, Anita Pálinkás, Ferenc Vincze, Nóra Kovács, Valéria Sipos, László Kőrösi, Zsófia Falusi, László Pál, Gergely Fürjes, Magor Papp, and et al. 2018. "Healthcare Utilization and All-Cause Premature Mortality in Hungarian Segregated Roma Settlements: Evaluation of Specific Indicators in a Cross-Sectional Study" International Journal of Environmental Research and Public Health 15, no. 9: 1835. https://doi.org/10.3390/ijerph15091835