Health care utilisation and perceived health at 12months followup after burn injury B Wikehult, J Dy

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Health care utilisation and perceived health at
12-months follow-up after burn injuryB
Wikehult, J Dyster-Aas, M Kildal,Uppsala
University Hospital
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Background

• A burn is often a severe trauma, which may have
  lifelong consequences.
• Besides causing visible scars, itching, impaired
  mobility and other physical problems, psychiatric
  problems are common.

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Depression after burns 1

• Pre-injury psychiatric illness among burn
  patients varies between 28 and 75 (Patterson et
  al, 1993)
• Post-injury depression occurs in between 2 and 54
  of patients (van Loey et al, 2003)
• Large differences in diagnostic methodology

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Depression after burns 2

• Women with facial burns may have greater risk for
  depression. (Fukunishi 1999, Wiechman et al,
  2001)
• The burn area seems to be of less importance for
  the risk of developing depression

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Physical problems after burns

• are related to the extent of burn injury
• Simple Abilities
• Treatment Regimens
• Work
• Heat Sensitivity
• Body Image
• Kildal et al (2002)

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Satisfaction of care

• Former burn patients are often dissatisfied with
  care during the rehabilitation phase (van Loey et
  al, 2001)
• Patient group demand for a multidisciplinary
  outpatient follow-up with respect to both
  psychosocial and physical problems

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The aim

• The aim of this study was to evaluate what type
  of health care burn survivors utilise during the
  first year after the injury.

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The research questions were

• How many subjects still utilise burn-related
  health care 12 months after the burn?
• Does burn severity have any importance for
  utilisation of health care 12 months after the
  injury?
• Are there differences in physical and
  psychiatric health status between those who
  utilise health care and those who do not?

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Subjects

• Admitted March 2000 - January 2005 199
• Excluded
• lt 18 years of age n 53
• Dementia or mental retardation n 25
• From other health care regions n 18
• No consent n 9
• Short LOS (lt 1 day) n 8
• Dead n 7
• Non-Swedish speaking n 6
• Other reasons for exclusion n 3 129
• Included 70
• Lost to follow up 13
• Analysed 57

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Description of subjects

• Included n 70
• Age LOS Burned Full thick-
• area ness burn
• Mean 44.4 25.7 24.5 10.0
• SD 15.5 29.0 20.1 14.3
• Range 19 90 1 - 183 0.5 80 0 63.5
• Excluded n 129
• Mean 35.2 13.8 6.2
• SD 29.7 18.4 11.3
• Range 0.6 - 91 1 - 155 0.2 - 61

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Measures 1

• Socio-demographic data (at injury and at 12
  months)
• age, gender, marital status and occupation
• A semi-structured telephone interview (at 12
  months) regarding health status and health care
  utilisation
• The question concerning health care utilisation
  was
• Do you still have contact with health care due
  to the burn?

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Measures 2

• The Burn Specific Health Scale-Brief (BSHS-B) is
  a 40-item, nine-factor scale used to assess post
  burn physical and psychosocial health.
• (at 12 month)
• Five scales reflect psychosocial difficulties
• Affective, Body image, Work, Interpersonal
  relationships, and Sexuality
• Four scales reflect physical difficulties
• Heat sensitivity, Simple abilities, Treatment
  regimens, Hand function

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Measures 3

• The Hospital Anxiety and Depression Scale, HADS,
  is a self-assessment scale for symptoms of
  anxiety and depression. It has two scales with
  seven items in each scale
• (at injury and at 12 months)

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Measures 4

• The Structured Clinical Interview for DSM IV
  psychiatric disorders, SCID-I, was performed
  twice (at injury and at 12 months) to diagnose
  major depression
• Measurements were made with request to three time
  periods
• Lifetime, i.e. at any time prior to the burn
• At injury
• 12-months post-burn.

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Statistical analyses

• Pearson correlation analyses
• Students t-test
• Chi-square

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Results
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Utilisation of care after 12 months

• Health Care utilisers n 25
• General Practitioner n 9
• Physiotherapist n 9
• Surgery n 7
• Rehabilitation clinic n 6
• Psychiatric clinic n 3
• Occupational therapist n 3
• Company health service n 2
• Other care n 8
• No health care utilisation n 32

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Sociodemographics

• The group of 25 with health care utilisation at
• 12-months follow-up had significantly
• larger burned area (plt0.05)
• longer length of stay in hospital (plt0.05)
• than the group of 32 without health care
  utilisation
• No differences in gender, age, marital status or
• occupation were found.

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Perceived burn related health (BSHS-B) 12 months
after the burn

• Subscales Health No health
• care care P-value
• mean(SD) mean(SD)
• Simple Abilities 3.43(0.7) 3.63(0.7) ns
• Heat Sensitivity 1.51(1.1) 2.04((1.3) ns
• Hand Function 3.33(0.9) 3.59(0.9 ) ns
• Treatment Regimens 2.22(1.1) 3.19(1.0 ) lt0.002
• Work 1.46(1.5) 2.76(1.4 ) lt0.002
• Body Image 2.18(1.2) 2.80(1.2 ) ns
• Affect 2.84(1.0) 3.02(1.0 ) ns
• Interpersonal Relationships 3.38(0.7) 3.48(1.0 )
  ns
• Sexuality 3.07(0.9) 3.13(1.0 ) ns

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Perceived burn related health (BSHS-B) 12 months
after the burn

• Subscales Health No health
• care care P-value
• mean(SD) mean(SD)
• Simple Abilities 3.43(0.7) 3.63(0.7) ns
• Heat Sensitivity 1.51(1.1) 2.04((1.3) ns
• Hand Function 3.33(0.9) 3.59(0.9 ) ns
• Treatment Regimens 2.22(1.1) 3.19(1.0 ) lt0.002
• Work 1.46(1.5) 2.76(1.4 ) lt0.002
• Body Image 2.18(1.2) 2.80(1.2 ) ns
• Affect 2.84(1.0) 3.02(1.0 ) ns
• Interpersonal Relationships 3.38(0.7) 3.48(1.0 )
  ns
• Sexuality 3.07(0.9) 3.13(1.0 ) ns

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Symptoms of anxiety and depression (HADS) 12
months after the burn

• Health No health
• care care P-value mean(SD) mean(SD)
• Symptoms of
• anxiety at injury 7.04 (5.33) 5.72 (5.46) ns
• depression at injury 7.56 (5.12) 4.75
  (5.28) lt0.05
• Total score at injury 14.6 (8.71) 10.47
  (10.06) ns
• Symptoms of
• anxiety at 12 months 5.92 (3.95) 5.14
  (4.07) ns
• depression at 12 months 4.75 (3.78) 4.38
  (4.57) ns
• Total score at 12 month 10.67 (7.26) 9.52
  (7.84) ns

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Frequencies of major depression (SCID-I)

• Lifetime At injury 12-months
• depression follow-up
• Health care utilisers 10 / 25 3 / 25 3 / 25
• No health care 13 / 32 6 / 32 4 / 32
• ns ns ns
• At 12-months follow-up 13 out of 57 subjects were
  on anti-depressants.

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Discussion 1

• Subjects with care utilisation the first year
  after trauma had larger burned area and longer
  hospital stay.
• Furthermore, they had more problems with
  self-care and more difficulties concerning their
  ability to work.

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Discussion 1

• Symptoms of depression measured with the HADS
  were common among burn patients, both during
  acute care and at 12 months.
• Those utilising health care had more symptoms of
  depression during acute care. There were,
  however, no differences in the formal diagnosis
  of major depression at this time.
• At 12-months follow-up there were no difference
  between the groups.

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Conclusion

• Almost half of the subjects utilised health care
  after 12 months.
• Although depression was common prior to the
  injury, the main reason for health care
  utilisation after 12 months was physical
  problems.

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Thank You