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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.

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

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