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Evidence for significant reductions in utilisation were strongest for interventions in respiratory and cardiovascular disorders.
Evidence for reductions in utilisation associated with self-management support was strongest in respiratory and cardiovascular problems.
In terms of hospital use, the bulk of studies are in the lower right quadrant (i.e. they are associated with improvements in health outcomes and reductions in utilisation).
Self-management support thus has potential to make a large impact on utilisation, because it is relevant to so many patients with long-term conditions, but this assumes that: (a) reductions in utilisation are achieved without compromising other outcomes (b) reductions in utilisation can be consistently achieved (c) self-management support can be disseminated widely.
Furthermore, quantitative evidence points to reductions in utilisation seen in vulnerable populations i.e., the poor, the elderly and the chronically ill; groups which comprise the GMS population in Ireland [ 36- 39].
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Furthermore, customers receive a discount regardless of whether a reduction in utilisation is achieved.
Recognizing these differences may be critical to effective treatment and reduction in utilisation.
To give a quantitative idea about this relatively low impact, it is not uncommon to find [ 30] that a one percentage increase in patient charges tends to lead to a reduction in utilisation of merely 0.2%.
Within this context, effective disease self-management – according to new models of chronic care [ 3] – can help to empower the patient and may aid in promoting a person's dignity, self-determination, and well-being, while at the same time, potentially achieving operational savings within health care systems through a reduction in utilisation.
Coordination of care could also have led to a shift of costs where new caregiver contacts may have contributed to a lack of reduction in total costs, even if there were some reductions in healthcare utilisation [24].
20 For example, Volkow et al 21 found obese subjects had decreased dopaminergic activity and reductions in glucose utilisation in dorsolateral prefrontal and OFC regions, areas important in inhibitory control and salience attribution.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com