RESUMEN
OBJECTIVE: To examine to what extent patients' hospital choices are influenced by travel time, their care history, and their general practitioners' (GP) referral history. DESIGN: Quantitative study. METHOD: We used care claims data from 2015 of patients with breast cancer. We selected the initial care products of the breast cancer patients who had been referred to a hospital by a GP or GP practice. We used conditional logit choice models with 82 hospitals in the choice set to assess whether travel time to the hospital, care history of the patient in the preceding two years, and referral history of the GP were related to the choice of hospital. How often patients opted for a default choice hospital was also determined. RESULTS: We identified 74,227 breast cancer care products representing the hospital choices of 70,608 unique patients (96% female; mean age 52.7 years) who originated from 4840 different GP practices. Travel time, the patient's care history, and GP referral history were all statistically significantly related to hospital choice. Patients more often visited a hospital where they had been before, with a shorter travel time, or where relatively more patients from the same GP practice went to for breast cancer care. The latter improved the model most, followed by patient's care history and travel time. Twelve percent of patients without previous care, and 7% of patients with a care history, did not opt for a default hospital; relatively often a university hospital or specialized hospital was chosen in these cases. CONCLUSION: Next to travel time, the patient's care history and the GP's referral history clearly contribute to the hospital choice of breast cancer patients. A considerable cohort opts to receive care in a hospital that, based on travel time, the patient's care history and GP referral history, would not be the default destination.
Asunto(s)
Neoplasias de la Mama/terapia , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Adulto , Conducta de Elección , Estudios de Cohortes , Femenino , Medicina General/estadística & datos numéricos , Hospitales/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , Factores de TiempoRESUMEN
The objective of this study was to explore how maternal mood during pregnancy, i.e., general anxiety, pregnancy-specific anxiety, and depression predicted parenting stress 3 months after giving birth, thereby shaping the child's early postnatal environmental circumstances. To this end, data were used from 1073 women participating in the Dutch longitudinal cohort Generations2, which studies first-time pregnant mothers during pregnancy and across the transition to parenthood. Women filled out the State Trait Anxiety Inventory (STAI), Pregnancy-Related Anxiety Questionnaire-revised (PRAQ-R), and Beck Depression Index (BDI) three times during pregnancy: at 12, 22, and 32 weeks gestational age. Three months postpartum, a parenting stress questionnaire was filled out yielding seven different parenting constructs. Latent scores were computed for each of the repeatedly measured maternal mood variables with Mplus and parenting stress constructs were simultaneously regressed on these latent scores. Results showed that trait anxiety and pregnancy-specific anxiety were uniquely related to almost all parenting stress constructs, taking depression into account. Early prevention and intervention to reduce maternal anxiety in pregnancy could hold the key for a more advantageous trajectory of early postnatal parenting.
Asunto(s)
Ansiedad/epidemiología , Ansiedad/psicología , Depresión Posparto/epidemiología , Depresión/epidemiología , Responsabilidad Parental/psicología , Padres/psicología , Complicaciones del Embarazo/psicología , Estrés Psicológico/epidemiología , Estrés Psicológico/etiología , Adulto , Ansiedad/diagnóstico , Trastornos de Ansiedad , Depresión/diagnóstico , Depresión/psicología , Depresión Posparto/diagnóstico , Femenino , Humanos , Estudios Longitudinales , Países Bajos/epidemiología , Inventario de Personalidad , Periodo Posparto/psicología , Embarazo , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/tratamiento farmacológico , Factores de Riesgo , Estrés Psicológico/diagnóstico , Estrés Psicológico/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: High levels of prenatal maternal anxiety - either pregnancy-specific anxiety or general anxiety - may have detrimental effects on both the mother and her child. It is currently unknown how these two different expressions of anxiety influence each other over time during pregnancy. AIMS: This study aimed to describe the relationship between state, trait and pregnancy-specific anxiety levels across pregnancy. METHODS: Longitudinal data from three data-waves of a large-scaled sample of nulliparous normal risk pregnant women were used to display associations over time by means of autoregressive and cross-lagged panel models. RESULTS: Cross-lagged, cross-time pathways from pregnancy-specific anxiety to state as well as trait anxiety were positively significant, while vice versa the most consistent links were found from trait anxiety to pregnancy-specific anxiety. CONCLUSIONS: We conclude that pregnancy-specific anxiety and general anxiety appear to influence each other over time, resulting in heightened anxiety for some soon-to-be mothers.