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Self-Management and Health Care Use in an Adolescent and Young Adult Medicaid Population With Differing Chronic Illnesses

Self-Management and Health Care Use in an Adolescent and Young Adult Medicaid Population With Differing Chronic Illnesses

ORIGINAL RESEARCH — Volume 12 — July 2, 2015

G. Alexandra Phillips; Nicole Fenton, PhD, MA; Sarah Cohen; Karina Javalkar; Maria Ferris, MD, PhD, MPH

Suggested citation for this article: Phillips GA, Fenton N, Cohen S, Javalkar K, Ferris M. Self-Management and Health Care Use in an Adolescent and Young Adult Medicaid Population With Differing Chronic Illnesses. Prev Chronic Dis 2015;12:150023. DOI: http://dx.doi.org/10.5888/pcd12.150023.

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On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Abstract

Introduction
 

Few studies of adults question the validity of the claim that self-management reduces the use of health care services and, as a result, health care costs. The aim of our study was to determine the relationship between self-management and health care use in a population of adolescent and young adult recipients of North Carolina Medicaid with chronic health conditions, who received care in either the pediatric or adult clinic. Our secondary objective was to characterize the patterns of health care use among this same population.

Methods
 

One hundred and fifty adolescents or young adults aged 14 to 29 were recruited for this study. Participants completed a demographics questionnaire and the self-management subdomain of the University of North Carolina TRxANSITION Scale. Information on each participant’s emergency department and inpatient use was obtained by using the North Carolina Medicaid Provider Portal.

Results
 

This cohort had a high level of emergency health care use; average lifetime use was 3.18 (standard deviation [SD], 5.58) emergency department visits, 2.02 (SD, 3.42) inpatient visits, and 12.5 (SD, 23.9 ) days as an inpatient. Age group (pediatric or adult), diagnosis, race/ethnicity, and sex were controlled for in all analyses. Results indicate that patients with a high rate of disease self-management had more emergency department visits and hospitalizations and a longer length of stay in the hospital than did those with a low rate.

Conclusion
 

In a group of North Carolina Medicaid recipients with chronic conditions, better self-management is associated with more health care use. This is likely the result of many factors, including more interactions with health care professionals, greater ability to recognize the need for emergency medical attention, and the use of the emergency department for primary health care.

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Introduction

As adolescents and young adults with chronic health conditions transition to adulthood, they usually become more responsible for their own care and rely less on their parents or guardians. With proper preparation for and development of self-management skills during the transition from pediatric to adult health care, youths have better health and face fewer negative health outcomes (1,2).

Recently, self-management programs have grown in popularity as studies link better self-management with improved health and lower health care use and costs (3–5). Few studies questioned the validity of the claim that self-management reduces the use of health care services and, as a result, health care costs (6,7). The majority of these studies focused on adult populations, rather than adolescents and young adults who are newly developing self-management skills. The relationship between self-management and use of health care services remains largely understudied in Medicaid populations.

In 2014, 66 million Americans (20% of the US population) had insurance coverage through Medicaid (8). With such a significant amount of the population using federal support for their health insurance, understanding the patterns and underlying factors of health care use by the Medicaid population should lead to more efficient practices and reduce health care costs. In studies of the Medicaid population, few differences exist in economic status, which allows studies to shift their focus to other factors.

The purpose of this study was to determine whether the pattern of self-management and health care use among Medicaid enrollees maintains or contradicts the assertion that better self-management in a broad population of people with chronic diseases results in fewer emergency department visits and hospitalizations. Our secondary objective was to characterize the health care use patterns of young North Carolina Medicaid recipients with chronic conditions. Our findings should be of use to self-management programs and health care practices for adolescents and young adults with chronic illnesses.

Acknowledgments

This investigation was partially funded by the University of North Carolina Kidney Center and the Renal Research Institute. We thank Dr. William Primack and Dr. Keisha Gibson for their assistance in recruiting participants for this study.

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Author Information

Corresponding Author: Maria Ferris, MD, PhD, MPH, University of North Carolina Kidney Center, 7021 Burnett Womack, CB No. 7155, Chapel Hill, NC 27514. Telephone: 919-966-4615. Email:maria_ferris@med.unc.edu.

Author Affiliations: G. Alexandra Phillips, Sarah Cohen, Karina Javalkar, Maria Ferris, The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina; Nicole Fenton, Dana-Farber/Boston’s Children Cancer and Blood Disorders Center, Boston, Massachusetts.

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References

1. Harvey PW, Petkov JN, Misan G, Fuller J, Battersby MW, Cayetano TN, et al. Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes. Aust Health Rev 2008;32(2):330–8. CrossRef PubMed
2. Sevick MA, Trauth JM, Ling BS, Anderson RT, Piatt GA, Kilbourne AM, et al. Patients with complex chronic diseases: perspectives on supporting self-management. J Gen Intern Med 2007;22(Suppl 3):438–44. CrossRef PubMed
3. Lorig KR, Sobel DS, Stewart AL, Brown BW Jr, Bandura A, Ritter P, et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med Care 1999;37(1):5–14. CrossRef PubMed
4. Ong SW, Jassal SV, Porter E, Logan AG, Miller JA. Using an electronic self-management tool to support patients with chronic kidney disease (CKD): a CKD clinic self-care model. Semin Dial 2013;26(2):195–202. CrossRef PubMed
5. Newman S, Steed L, Mulligan K. Self-management interventions for chronic illness. Lancet 2004;364(9444):1523–37. CrossRef PubMed
6. Jaglal SB, Guilcher SJ, Hawker G, Lou W, Salbach NM, Manno M, et al. Impact of a chronic disease self-management program on health care utilization in rural communities: a retrospective cohort study using linked administrative data. BMC Health Serv Res 2014;14:198. CrossRef PubMed
7. Kennedy A, Rogers A, Bower P. Support for self care for patients with chronic disease. BMJ 2007;335(7627):968–70. CrossRef PubMed
8. The Henry K. Kaiser Family Foundation. Medicaid moving forward. 2014. http://kff.org/medicaid/fact-sheet/the-medicaid-program-at-a-glance-update/. Accessed December 8, 2014.
9. Ferris ME, Harward DH, Bickford K, Layton JB, Ferris MT, Hogan SL, et al. A clinical tool to measure the components of health-care transition from pediatric care to adult care: the UNC TR(x)ANSITION scale. Ren Fail 2012;34(6):744–53. CrossRef PubMed
10. Shatin D, Levin R, Ireys HT, Haller V. Health care utilization by children with chronic illnesses: a comparison of Medicaid and employer-insured managed care. Pediatrics 1998;102(4):E44.CrossRef PubMed
11. Grossman LK, Rich LN, Johnson C. Decreasing nonurgent emergency department utilization by Medicaid children. Pediatrics 1998;102(1 Pt 1):20–4. CrossRef PubMed
12. Bourbeau J, Julien M, Maltais F, Rouleau M, Beaupre A, Begin R, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention. J Cardiopulm Rehabil 2004;24(4):282–3. CrossRef
13. Capomolla S, Febo O, Ceresa M, Caporotondi A, Guazzotti G, La Rovere M, et al. Cost/utility ratio in chronic heart failure: comparison between heart failure management program delivered by day-hospital and usual care. J Am Coll Cardiol 2002;40(7):1259–66. CrossRef PubMed
14. Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW Jr, Bandura A, et al. Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care 2001;39(11):1217–23. CrossRef PubMed
15. Eaton T, Young P, Fergusson W, Moodie L, Zeng I, O’Kane F, et al. Does early pulmonary rehabilitation reduce acute health-care utilization in COPD patients admitted with an exacerbation? A randomized controlled study. Respirology 2009;14(2):230–8. CrossRef PubMed
16. Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease. Eff Clin Pract 2001;4(6):256–62. PubMed
17. Panagioti M, Richardson G, Small N, Murray E, Rogers A, Kennedy A, et al. Self-management support interventions to reduce health care utilisation without compromising outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2014;14(1):356. CrossRef PubMed