Health Care-Seeking Behaviors of Medicare Beneficiaries with - - PowerPoint PPT Presentation

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Health Care-Seeking Behaviors of Medicare Beneficiaries with - - PowerPoint PPT Presentation

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Health Care-Seeking Behaviors of Medicare Beneficiaries with Functional Hearing Loss Wakako Horiuchi; Amber Willink, PhD; Nicholas S. Reed, AuD Feb 2019 ACP Hawaii Chapter 2019 Scientific Meeting 1 Hearing loss in the US Prevalence of

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Feb 2019 1

Health Care-Seeking Behaviors of Medicare Beneficiaries with Functional Hearing Loss

Wakako Horiuchi; Amber Willink, PhD; Nicholas S. Reed, AuD

ACP Hawaii Chapter 2019 Scientific Meeting

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Hearing loss in the US

10 20 30 40 50 60 70 80 90

12-49 years 50-59 years 60-69 years 70-79 years ≥ 80 years Prevalence (%)

Age

Prevalence of bilateral hearing loss by severity in the United States

Severe Moderate Mild

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HL and health outcomes

  • Hearing loss is independently associated with

– Cognitive decline – Dementia – Falls – Increased hospitalization, 30-day readmission, health care costs – Lower perceived satisfaction with care

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HL on patient-provider communication

  • Hearing loss is associated with poorer and more

limited patient-provider communication

– Reduced treatment adherence – Poor health care outcomes

  • Poor communication & experiences may manifest

in avoidance of the health care system

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Objective

  • Investigate the relationship between

self-reported functional hearing loss and health care-seeking behaviors of

  • lder Medicare beneficiaries
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Methods – Data Source

  • Medicare Current Beneficiary Survey (MCBS) 2015

– Participants (or their proxies) were interviewed in-person by a trained interviewer using computer-assisted personal interviewing software on laptop computers – Demographic, socioeconomic, health access, and satisfaction information – Nationally-representative sample of the Medicare population – 12,311 community-dwelling Medicare beneficiaries aged 65+ surveyed

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Methods – HL variable

  • Functional hearing loss

– “Which statement best describes your hearing [with a hearing aid]?”

  • “No trouble”
  • “A little trouble”
  • “A lot of trouble”
  • Hearing aid use
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Methods – Delay variable

  • Knowingly delaying health care

– “During the [current year] did you have any health problem or condition about which you think you should have seen a doctor or medical person, but did not?”

  • Follow-up:

– “Which [was] the main reason you did not see a doctor about [your] condition?”

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Methods – Covariates

  • Anderson-Aday model for health services use

– Predisposing factors

  • Sociodemographic: age, gender, race

– Enabling factors

  • Education, income, marital status, time to get to doctor’s office

– Need factors

  • Self-perceived general health status, ADLs, IADLs,

depression, number of doctor office visits in the current year

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Methods – Statistical Analysis

  • Survey weighting
  • Descriptive and univariate chi-square
  • Multivariate logistic regression
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RESULTS

Feb 2019 ACP Hawaii Chapter 2019 Scientific Meeting 11

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Study Cohort

Functional Hearing Status Variable No trouble A little Trouble A lot of Trouble

Hearing status of total sample 54.16% 39.39% 6.45% Delayed Care 8.48% 12.53% (P<0.001) 16.95% (P<0.001) Hearing aid use 6.89% 15.21% (P<0.001) 28.73% (P<0.001)

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Study Cohort

Functional Hearing Status Variable No trouble A little Trouble A lot of Trouble

Hearing status of total sample 54.16% 39.39% 6.45% Delayed Care 8.48% 12.53% (P<0.001) 16.95% (P<0.001) Hearing aid use 6.89% 15.21% (P<0.001) 28.73% (P<0.001)

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Study Cohort

Functional Hearing Status Variable No trouble A little Trouble A lot of Trouble

Age (years) 64 and younger 17.12% 13.26% 15.84% 65-74 53.45% 47.37% 36.12% 75 and older 29.43% 39.37% (P<0.001) 48.04% (P<0.001)

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Hearing loss and delay in access

0.000 0.500 1.000 1.500 2.000 2.500 3.000

Odds Ratio

Odds of delaying care by level of hearing loss

A little trouble A lot of trouble Hearing Aid Use

1.61 (1.33-1.95), P<0.001 2.01 (1.44-2.80), P<0.001 0.55 (0.39-0.78), P=0.001

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HL and delay - Predisposing

Odds Ratio 95% CI P

Age (years) 64 and younger REF 65-74 0.80 0.65-0.98 0.03 75 and older 0.54 0.43-0.70 <0.001 Gender - Female 1.38 1.13-1.67 0.001 Race Non-Hispanic White REF Non-Hispanic Black 1.15 0.87-1.52 0.32 Hispanic 1.08 0.79-1.48 0.62 Other 1.60 1.14-2.25 0.01

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HL and delay - Enabling

Odds Ratio 95% CI P

Educational attainment Less than 9th grade

REF

High school or vocational, technical, business degree

1.21 0.93-1.58 0.16

More than high school

1.17 0.90-1.53 0.24

Income - ≥$25,000

1.15 0.93-1.43 0.21 Married 0.78 0.70-0.91 0.003

Time of transportation to doctor's office 0-15 minutes

REF

16-20 minutes

1.01 0.84-1.22 0.90

31-59 minutes

1.03 0.71-1.49 0.87

60-119 minutes

0.99 0.66-1.50 0.97

2 hours or more

1.52 0.71-3.26 0.28

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HL and delay - Need

Odds Ratio 95% CI P General health Excellent REF Very good 1.16 0.83-1.62 0.39 Good 1.48 1.11-1.97 0.01 Fair 2.00 1.40-2.86 <0.001 Poor 2.03 1.36-3.04 0.001 Functional limitations No functional limitations REF

  • nly IADLs

2.02 1.50-2.71 <0.001 1-2 ADLs 1.89 1.32-2.69 0.001 3-4 ADLs 2.64 1.86-3.75 <0.001 5-6 ADLs 2.01 1.30-3.10 0.002

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HL and delay - Need

Odds Ratio 95% CI P Depression 1.58 1.29-1.94 <0.001 Total office visits in current year

No office visits REF 1-5 office visits 1.12 0.88-1.43 0.36 6-10 office visits 1.00 0.82-1.23 0.99 11-15 office visits 0.79 0.56-1.11 0.17 16-20 office visits 0.64 0.39-1.05 0.08

21 or more office visits 0.52 0.32-0.84 0.01

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Reasons for Delaying Care

0% 10% 20% 30% 40%

Didn't think the problem was serious Thought it would cost too much Trouble finding/getting to doctor Time/schedule

  • r personal

conflicts Thought doctor couldn't do much about problem Was afraid of finding out what was wrong Doctor would not accept my insurance Other

Percentage of group respondents No Trouble Hearing A little Trouble Hearing A lot of Trouble Hearing

Reasons given for delaying care by functional hearing status

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Reasons for Delaying Care

0% 10% 20% 30% 40%

Didn't think the problem was serious Thought it would cost too much Trouble finding/getting to doctor Time/schedule

  • r personal

conflicts Thought doctor couldn't do much about problem Was afraid of finding out what was wrong Doctor would not accept my insurance Other

Percentage of group respondents No Trouble Hearing A little Trouble Hearing A lot of Trouble Hearing

Reasons given for delaying care by functional hearing status

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Reasons for Delaying Care

0% 10% 20% 30% 40%

Didn't think the problem was serious Thought it would cost too much Trouble finding/getting to doctor Time/schedule

  • r personal

conflicts Thought doctor couldn't do much about problem Was afraid of finding out what was wrong Doctor would not accept my insurance Other

Percentage of group respondents No Trouble Hearing A little Trouble Hearing A lot of Trouble Hearing

Reasons given for delaying care by functional hearing status

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Conclusions

  • Persons with functional hearing loss had

significantly higher odds of knowingly delaying health care independent of predisposing, enabling, and need factors.

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Conclusions

  • Reason for delay: participants believed the doctor

couldn’t do anything about their health care problem – Previous miscommunication experience

  • Poorer, inefficient care
  • Contribution to avoidance behavior

– Hearing loss and psychosocial outcomes

  • Social isolation
  • Depression
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Strengths and Limitations

Strengths

  • This is the first analysis of

a nationally representative Medicare population to associate functional hearing loss and general health care- seeking behaviors

– Large study population

Limitations

  • Cross-sectional, cannot

assess temporality trends

  • Self-report

– Hearing aid use dependent

  • n appropriate use and fit
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Future Directions

  • Further study should utilize objective

measures of hearing loss and longitudinal data

  • Implications for health care service delivery

and planning

– Improving patient-provider experience for persons with hearing loss

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Thank you

Acknowledgements

  • Dr. Kamal Masaki
  • Misty Yee
  • Dr. Frank R. Lin
  • Dr. Colleen Christmas
  • Dr. Sevil Yasar
  • Dr. Samuel C. Durso

Funding and Disclosure

  • National Institute on

Aging (NIA) Medical Student Training in Aging Research

  • I have no actual or

potential conflict of interest in relation to this program/presentation.

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SUPPLEMENTAL FIGURES

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Hearing loss in the US

5% 7% 14% 30% 44% Prevalence of bilateral hearing loss in the United States

12-49 years 50-59 years 60-69 years 70-79 years ≥ 80 years

Goman A, Lin F. Prevalence of Hearing Loss by Severity in the United States. AJPH (2016)

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Hearing loss in the US

10 20 30 40 50 60 70 80 90

Mild Moderate Severe Overall

Prevalence (%)

Hearing Loss Severity

Prevalence of bilateral hearing loss by severity in the United States

12-49 y 50-59 y 60-69 y 70-79 y ≥ 80 y

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Reasons

36.20% 10.63% 4.53% 6.55% 12.87% 8.58% 2.10% 18.55% 30.97% 10.91% 5.55% 8.53% 9.99% 7.92% 1.72% 24.41% 27.38% 26.56% 2.32% 6.54% 19.82% 6.77% 0.00% 10.61%

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 40.00% 45.00% 50.00% Didn't think the problem was serious Thought it would cost too much Trouble finding/getting to doctor Time/schedule or personal conflicts Thought doctor couldn't do much about problem Was afraid of finding out what was wrong Doctor would not accept my insurance Other

Percentage of group respondents Reason for delaying care

Reasons given for delaying care by functional hearing status

No Trouble Hearing A little Trouble Hearing A lot of Trouble Hearing

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Methods – Secondary analysis

  • Additional factors in seeking health care

– Worrying about health – Seeking care right away – Avoiding care – Disclosing illness to others – Attempts to contact a physician for delayed problem

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Secondary analyses

  • 0.500

0.000 0.500 1.000 1.500 2.000 2.500

OR (95% CI)

Odds by degree of functional hearing loss

A little trouble hearing A lot of trouble hearing With hearing aid

0.886 (0.750-1.047) 0.763 (0.552-1.054) 0.782 (0.631-0.968) 1.154 (1.006-1.325) 1.169 (0.945-1.447) 0.973 (0.817-1.158) 1.115 (0.983-1.265) 1.177 (0.966-1.433) 0.817 (0.671-0.996) 0.773 (0.681-0.877) 0.842(0.655-1.080) 0.961 (0.832-1.110) 1.051 (0.687-1.608) 0.970 (0.536-1.757) 0.893 (0.517-1.542) Worries about health Avoids going to the doctor Keeps info about illness to self Sees doctor ASAP when sick Attempt to get care for delayed problem

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Secondary analyses

Worries about health Avoids going to the doctor Keeps info about illness to self Functional Hearing Loss OR (95% CI) SE P OR (95% CI) SE P OR (95% CI) SE P

No trouble REF REF REF A little trouble 0.886 (0.750-1.047) 0.074 0.152 1.115 (0.983-1.265) 0.071 0.088 1.154 (1.006-1.325) 0.08 0.042 A lot of trouble 0.763 (0.552-1.054) 0.124 0.100 1.177 (0.966-1.433) 0.117 0.104 1.169 (0.945-1.447) 1.126 0.148 Hearing Aid Use 0.782 (0.631-0.968) 0.084 0.024 0.817 (0.671-0.996) 0.081 0.045 0.973 (0.817-1.158) 0.085 0.753

Sees doctor ASAP when sick Attempt to get care for delayed problem Functional Hearing Loss OR (95% CI) SE P OR (95% CI) SE P

No trouble REF REF A little trouble 0.773 (0.681-0.877) 0.049 0.000 1.051 (0.687-1.608) 0.225 0.816 A lot of trouble 0.842(0.655-1.080) 0.106 0.174 0.970 (0.536-1.757) 0.290 0.919 Hearing Aid Use 0.961 (0.832-1.110) 0.070 0.585 0.893 (0.517-1.542) 0.246 0.681