Dyskinesia may adversely affect QOL and increase health care costs in patients with PD
Among those with parkinsonism co-morbidity cost ratios demonstrated two- to threefold higher cost for dementia broken bones broken hip and diabetes Co-morbidity associated with parkinsonism is related to higher resource use and expenditures
144 Brazilian Patients with PD Cross-sectional survey Utilization of healthcare resources was influenced by functional status and co-morbid conditions
194
Table 2 Design of the Draft Questionnaire Variables and Definitions Variables Definitions
Health Care Utilization Utilization of Medical Services
Emergency rooms Attendances in emergency rooms over the past 2 years
Hospitalization Inpatient stays stays overnight or longer at clinics over the past 2 years
Outpatient visits Attendances at clinics or hospitals others than as an inpatient over the past 3 months
Rehabilitation Consultation by a physiotherapist because of PD over the past 3 months
Utilization of ldquochronic illness prescription refill sliprdquo (CIPRS)
Whether participants become the lsquochronic illness prescription refill sliprsquo due to PD over the past 3 months or not
Utilization of CAM Utilization of alternative therapy
Consultation by a alternative medicine provider because of PD over the past 3 months
Utilization of supplemental health food
Use of any supplemental health food over the past 3 months because of PD
Utilization of supportive devices
Use any supportive devices such as canes or wheelchairs over the past 3 months because of PD
Utilization of Care Services
Utilization of foreign domestic worker
Informal care provided by foreign domestic worker over the past 3 months
Utilization of family care Informal care provided by family member(s) over the past 3 months
Utilization of social care Whether participants have become any social care services over the past 3 months because of PD
Age The actual age in years Gender Male and female groups Predisposing Characteristics
Education level The educational level of the participants
Marital status A legally recognized civil partnership The number of children The number of children Living arrangements Information about cohabiting Disablility Disability relating to ADL and IADL Need Disease severity Disease severity based on UPDRS Disease duration The actual duration in years after the diagnosis of PD Co-Morbidity Number of other diseases which participants have totally Household expenditure The total amount for the household monthly Enabling Resources Ownership of the
lsquohandicapped IDrsquo Ownership of the lsquohandicapped IDrsquo due to mental andor physical disabilities
Social support Perceived support (from family friends and neighbors) for use of health care services
Disease-related knowledge Participantsrsquo knowledge about the necessity of regular doctor
visits and medication due to PD Psychological Characteristics
Social welfare related knowledge
Participantsrsquo knowledge about the lsquohandicapped IDrsquo health insurance subsidy and social care services due to PD
Attitudes towards health care
An index based on Andersen (1973) participantsrsquo perception towards health care services
The social norms referent who is mostly involved in the processes of health care utilization
Selectivecompensatory control
adapted from Health Engagement Control Strategy (Wrosch Schulz amp Heckhausen 2002)
195
Table 3 Items and Scales Used in the Development of the Draft Questionnaire
Item Source Number of items
Predisposing Characteristics
adapted from the health care utilization studies in people with intellectual disabilities in Taiwan (Lin et al 2005 2007 )
6
Need
IADL adapted from Lawton amp Brody (1969) 8
Disease severity adapted from the UPDRS 55
Disease duration self-developed 1
Co-Morbidity A check-list with 14 chronic disease developed from Lin et al (2005 2007)
15
Enabling Resources
Social support adapted from the MOS Social Support Survey 19
Ownership of the Handicapped ID
adapted from Lin et al (2005 2007) 3
Self-evaluated economic status and household expenditure
1 item adapted from the OASIS Study (Lowenstein amp Ogg 2003)
1 item adapted from Lin et al (2005 2007)
2
Psychological Characteristics
Disease-related knowledge self-developed 2
Social welfare related knowledge
developed from Lin et al (2005 2007) 3
Attitudes towards health care services
adapted from Andersen (1976) 3
Social norms self-developed based on Bradley et al (2002) 1
Perceived control adapted from Health Engagement Control Strategy
(Wrosch Schulz amp Heckhausen 2002)
12
Health Care Utilization
Utilization of medical services
developed from PD MED 6
Utilization of alternative therapy
adapted from PD MED 1
Utilization of health food self-developed 1
Utilization of supportive devices
adapted from Lin et al (2005 2007) 1
Utilization of social care developed from PD MED 1
Utilization of family care developed from PD MED 2
Depressive Symptoms
adapted from CES-D 10
HRQOL
Health-related quality of life adapted from the Chinese Version of PDQ-8 (Tan Lau Au amp Luo 2007)
adapted from SF-12
8
12
196
Table 4 Items and Scales Used in the Final Questionnaire
Item Source Number of items
Predisposing Characteristics
adapted from Lin et al (2005 2007) 6
Need Level
ADL Bethel Index (Mahoney amp Barthel 1965) (assessed by the author) (10)
IADL adapted from Lawton amp Brody (1969) 8
Disease severity adapted from the Hoehn-Yahr Scale 1
Disease duration self-developed 1
Co-Morbidity A check-list with 14 chronic disease (Lin et al 2005 2007) 2
Enabling Resources
Social support adapted from the MOS Social Support Survey (partial) 5
Ownership of the Handicapped ID
adapted from Lin et al (2005 2007) 3
Self-evaluated economic status
1 item adapted from the OASIS Study (Lowenstein amp Ogg 2003) 1 item adapted from Lin et al (2005 2007)
2
Psychological Characteristics
Disease-related knowledge self-developed 3
Social welfare related knowledge
developed from Lin et al (2005 2007) 3
Attitudes towards health care services
adapted from Andersen (1976) 3
The social norms self-developed based on Bradley et al (2002) 1
Perceived control adapted from Health Engagement Control Strategy (Wrosch Schulz amp Heckhausen 2002)
12
Health Care Utilization
Utilization of medical services
developed from PD MED 6
Utilization of alternative therapy
adapted from PD MED 1
Utilization of supplemental health food
self-developed 1
Utilization of supportive devices
adapted from Lin et al (2005 2007) 1
Utilization of family care developed from PD MED 1
Utilization of foreign domestic worker
self-developed 1
Utilization of social care developed from PD MED 1
Depressive Symptoms
adapted from GDS-15 (Yesavage et al 1983) 15
HRQOL
adapted from SF-12 12
197
Table 5 Scale Reliability of IADL MOS SSS (5 items) PDQ-9 HECS GDS-15 and SF-12
Scale Item Number Cronbachrsquos Alpha
IADL
8
88
MOS SSS
5
80
PDQ-8
8
95
HECS
12
91
GDS-15
15
89
SF-12
12
86
198
Table 6 Descriptive Statistics of the Predisposing Characteristics and Enabling Resources among the Study Sample
N M SD Rangea
Gender
Male 104 52
Age 200 7507 747 65ndash92
Education Level
Illiterate 37 185
Primary school 46 23
Junior high school 40 20
Senior high school 33 165
College degree 44 22
Marital Status
married 115 55
widowed 71 355
single 15 75
The Number of Children 316 172 0ndash8
Living Arrangements
3-Generation Household 112 56
With Spouse Only 41 205
Alone (community-dwelling) 16 8
Senior Housing 2 1
Care Facility or Nursing Home 29 145
Household Expenditure
lt 7999 NT$ 3 15
8000ndash19999 NT$ 20 10
20000ndash39999 NT$ 49 245
40000ndash59999 NT$ 63 315
gt60000 NT$ 53 36
No Exact Answer 12 6
Ownership of the Handicapped ID
With 49 245
10
21 15 3
204 429 306 61
Handicap Level Mild Moderate Severe Profound Social Support 200 2111
419
Note a Observed range
199
Table 7 Descriptive Statistics of the Need Level among the Study Sample
N M SD Rangea
ADL 200 7317 3139 0ndash100
IADL 200 717 467 0ndash12
Disease Severity (based on Hoehn amp Yahr Scale) 200 249 149 1ndash5
1 unilateral involvement 80 40
2 bilateral involvement 28 14
3 postural instability 38 19
4 severly disabled 23 115
5 restricted to bed or wheelchair 31 155
Co-Morbidity (number of chronic disorders)
0 42 21
1 35 175
2 29 145
3 42 21
4 27 135
gt=5 25 125
Disease Duration (years) 199 651 496 0ndash20
lt 1 year 10 5
= 1 year 28 141
2 ndash 5 years 55 2763
6 ndash 10 years 67 3367
11 ndash15 years 33 1658
15ndash20 years 6 301
Note a Observed range
200
Table 8 Responses on Perceived Control (by percentage)
Item Item mean
Never
Selten
Some- times
Often
Always
1 I invest as much time and energy as possible to improve my health
215 95 210 235 365 95
2 Even if my health is in very difficult condition I can find something positive in life
209 90 190 310 360 50
3 If I develop a new health problem I immediately get help from a health professional (eg doctor nurse)
254 55 135 260 320 230
4 When I decide to do something about a health problem I am confident that I will achieve it
193 120 240 275 320 45
5 I do whatever is necessary to be as healthy as I possibly can be
217 95 19 285 315 115
6 When a treatment doesnrsquot work for a health problem I have I try hard to find out about other treatments
200 125 200 290 300 75
7 When I am faced with a bad health problem I try to look at the bright side of things
215 125 180 215 375 105
8 Once I decide what I need to do to improve my health I avoid things that could distract me from doing these things
188 130 235 315 265 55
9 If I have a health problem that gets worse I put in even more effort to get better
206 135 210 220 330 105
10 When I first notice a health problem I try to get as much advice as I can from people who might know something about the problem
236 70 180 275 265 205
11 When I find it impossible to overcome a health problem I try not to blame myself
212 95 165 340 330 70
12 I often think about how important good health is to me
257 55 105 26 375 205
201
Table 9 Self-reported Health Care Utilization (in Numbers and Percentages)
Health Care Utilization (by Services) N Use () Non-use ()
OPD (Out-patient Services) 200 138
(69)
62
(31)
ER (Emergency Rooms) 200 45
(225)
155
(775)
Hospitalization 200 63
(315)
137
(685)
REHAB 200 51
(255)
149
(745)
CIPRS 200 125
(625)
75
(375)
Alternative Therapy 199 64
(32)
135
(675)
Supportive Devices 200 111
(555)
89
(445)
Supplemental Health Food 200 86
(43)
114
(57)
Family Care 200 96
(48)
104
(52)
Foreign Domestic Worker 200 46
(23)
154
(77)
Social Care 200 14
(7)
186
(93)
202
Table 10 Spearman Rho Correlation Coefficients between Diverse Types of Health Care Utilization
Health Care Service 1 2 3 4 5 6 7 8 9 10
1 Hospitalization 105 344 347 318 194 499 294 490 -102
2 OPD 045 -430 -094 -095 -078 -070 -027 -240
3 REHAB 358 286 164 316 -020 310 -026
4 CIPRS 374 360 512 178 496 -030
5 Alternative Therapy 449 381 219 369 -021
6 Health Food 392 269 298 039
7 Supportive Device 442 578 088
8 Foreign Domestic Worker 236 -150
9 Family Care -067
10 Social Care
Note plt05 plt01 plt001
203
Table 11 Pearsonrsquos Correlation Coefficients between the Continuous Study Variables
Variable 1 2 3 4 5 6 7 8
1 Age 308 -365 -449 444 447 -197 -067
2 Number of Children -206 -302 318 302 -249 -298
3 ADL 828 -762 -853 533 431
4 IADL -765 -831 624 470
5 Disease Duration 895 -611 -518
6 Disease Severity (HY stage) -611 -471
7 Selective Control 844
8 Compensatory Control
Note (1) plt05 plt01 (2) correlation coefficients (2-tailed)
204
Table 12 Correlation Coefficients between the Non-Continuous Study Variables
Variable 1 2 3 4 5 6 7 8 9 10 11 12
1 Gender -330 296 003 -118 -022 -042 043 120 -136 248 159
2 Education Level -142 -159 -179 141 -033 -272 -109 402 -438 -173
3 Marital Status 173 013 -186 -086 253 229 -062 172 159
4 Living Arrangement 439 -126 351 332 127 -071 186 171
5 Handicapped ID -044 255 330 112 131 286 068
6 Household Expenditure 306 123 133 -136 007 119
7 Social Support 114 084 -085 144 075
8 Co-Morbidity 368 -240 432 293
9 Disease-related Knowledge 090 287 533
10 Social Welfare related Knowledge -270 -084
11 Social Norms 140
12 Attitudes
Note (1) plt05 plt01 (2) correlation coefficients (2-tailed)