2023
Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic
Authors:
Kosteniuk, J. G.*, Morgan, D. G.*, Osman, B. A., Islam, N., O'Connell, M. E.*, Kirk, A.*, Quail, J. M., & Osman, M.
Journal:
Canadian geriatrics journal
Abstract
Background: Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC).
Methods: Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort (N = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer’s disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly.
Results: Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all p <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period (p = .037).
Conclusions: A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.
Keywords: Alzheimer’s disease; dementia; drug prescriptions; health services research; hospitals; physicians; retrospective studies; rural health.
Plain language summary
Background: It is known that there are differences in how people with dementia use health services in urban settings (in cities) compared to rural areas. However, the extent of these differences in health service use over a long observation period, and prior to dementia diagnosis, have not been studied enough. The purpose of this study was to examine yearly rural-urban differences in the 5-year period before and 5-year period after a first diagnosis of dementia. We looked specifically at the proportion of patients using health services, and the average number of each service per person.
Methods: This study used administrative health data from the Canadian province of Saskatchewan to investigate the use of five health services (family physician, specialist physician, hospital admission, all-type prescription drug dispensations, and short-term hospital care admission) each year from April 2008 to March 2019. Persons with dementia in this study included 2,024 adults aged 65 years and older diagnosed from 1 April 2013 to 31 March 2014 (617 rural; 1,407 urban).
Results: Rural compared to urban persons with dementia had a lower average number of family physician visits during 1-year and 2-year before diagnosis and between 2-year and 4-year after diagnosis, a lower likelihood of at least one specialist physician visit (all specialties other than family medicine) and a lower average number of specialist physician visits during each year, and a lower average number of all-type prescription drug dispensations for most of the 10-year study period. Rural-urban differences were not observed in admission to hospital or short-term institutional care.
Conclusions: Geographic differences in the use of physician services and all-type prescription medication may indicate unmet dementia care needs in rural communities. Health system planners and educators must determine how to use existing resources and technological advances to provide quality care for rural persons living with dementia despite lower specialist physician access.
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