Lupine Publishers | Scholarly Journal of Food and Nutrition
Abstract
Introduction: Due to the nature of hospitals, the importance of mental
relaxation along with the physical health of patients, this study was conducted
to investigate the anxiety of hospitalized patients(discharge), looking at the
impact of health costs on the rate Anxiety.
Materials and methods: This cross-sectional descriptive-analytic study was carried
out using a researcher-made questionnaire. The statistical population of the
study included 80 patients with myocardial infarction referring to the Hospital
of Farmanieh, Tehran from 23 October to 21November 2017, 12 of whom were
discontinued for some reason and 68 completed the questionnaire. The collected
data were analyzed using SPSS software and sequential regression statistical
test.
Findings: There was a significant relationship between pay out of
pocket, employment status and insurance and the amount of anxiety; variables such
as age, gender and marital status did not have a significant relationship with
patient anxiety. Among the factors indicating anxiety, they received too much
concern about the cost of treatment and sleep disturbances in relation to
treatment costs, respectively with the highest and lowest levels of financial
anxiety.
Conclusion: According to the results, increasing pay out of pocket has
a positive effect on patient’s anxiety.
Keywords: Anxiety, Out of Pocket Payment, Myocardial Infarction
Introduction
Anxiety and anxiety disorder is a
great health problem, which involves many dimensions including health, finance,
family, and work. Over time, symptoms of anxiety may get worse or better, but
usually it gets exacerbated when stress occurs [1]. According to development of
health-related issues, and the increase in the cost of health-care
interventions, a distinct part of household income is allocated to these costs.
On the other hand, the fall in the value of household income, due to rising
inflation rates, and economic constraints, leads to double pressure on
households. Recent investigations shows that the decline of the socioeconomic
level can negatively impact on the health status of individuals, while
societies and mortality factors evolve, the decline in socio-economic status of
individuals can remove them from access to resources that protect or enhance
their health against harm caused by dangers. As a result, socioeconomic
benefits can increase the health, and reduce the health risk factors. Education
and occupation are two key factors in determining household income, which are
important determinants, in the individual and household’s socio-economic status
[2].
Family, as the most important unit
of society, plays an important role in the individual’s health and ability to
adapt to different situations. But some factors can affect the health of the
family abruptly and change its structure. Several stressors, such as acute and
severe illness, or hospitalization of one of the members, can lead the family
to anxiety and crisis. Various studies show that, from every 4 to 5 people, one
person suffers from psychiatric disorders each year due to stress. Therefore,
it is essential that some protections and strategies used to prevent and reduce
the anxiety risk factors [3]. One of these risk factors that always causes
increased stress and anxiety at the onset time of illness, is the psychological
stress caused by the inability to pay treatment costs.
According to a recent WHO report,
death in the 10 past years have been the highest rates of heart disease (15
million deaths in 2015, 17 million deaths in 2008) [4]. Anxiety is always one
of the causes of heart disease, which at the same time is one of the side
effects of the disease. Anxiety is one of the most commonly diagnosed
psychiatric patients’ responses to cardiovascular events which may lead to
physical or psychological consequences if they continue or intensify [5,6].
Expecting cardiac surgery, hospitalization, fear of death, hearing about the
deaths of people with the same disease, and generally fear of unknowing and
unknown causes anxiety in the patient and his fellows [7].
According to a study by Jeff C
Huffman [8], the anxiety among heart patients is common, and 20 to 50% of these
patients have expressed anxiety. Panthee [9] in their study concluded that
patients with myocardial infarction had a high degree of anxiety, which reduced
their quality of life [9]. According to these studies, the purpose of this
study was to investigate the financial anxiety of patients referred to cardiac
problems (with a priority of myocardial infarction), at the time of discharge
from the hospital, so that if the cost of treatment is effective on anxiety of
patients, in addition to other stressors, we will achieve some strategies to prevent
and ultimately reduce the psychological effects of hospital costs, because the
main goal of each health center is to reduce suffering and relieve the clients,
not to add to their inconveniences and concerns.
Materials and Methods
The present study is
descriptive-analytic, cross-sectional, and questionnaire based evaluation
(validated by experts). The study population included patients with myocardial
infarction referring to the Hospital of Farmanieh, Tehran, from October 23 to
November 21, 2017. The reason for randomly choosing of these patients was the
high cost of their treatment in all over the world, as well as the high
frequency of this disease patient, compared to the rate of disease and its
costs in other patient groups. The sample size is 65 and we recruited 15 more
patients for sample loss probability. After the census, 68 were willing to
participate in the research with oral satisfaction (7 people died and 5 did not
agree to do research).
In order to determine the level of
financial anxiety of patients, we used 6 questionnaires, five options Likert,
with the options, very high (5), high (4), medium (3), little (2), and very
little (1). Grades were classified as follows: 1-2.5 for low anxiety levels,
2.5-3.5 for moderate anxiety, and more than 3.5 for high anxiety levels. Also,
to investigate the total cost of patients, and the direct payment share, we
inquired about the discharge unit, and we filed the sums. Paid patients out of
pocket were also 38% nationwide, based on reported rates (referrals), and
patients were divided into two groups, pay out pocket up 38%, and pay out of
pocket more than 38% . The variables of the research are described in the table
below Table 1. The data were analyzed by SPSS software version 22 and
sequential regression tests at individual level (crude chance ratio) and
overall level, and the findings were reported in terms of odds ratio,
confidence interval, and amount meaningful.
Findings
The demographic data of 68 patients
were presented in Table 2. Most patients were female (69.1%), employees
(44.1%), married (83.8%), and in the age group of 31-60 (45.6%). According to
the research findings, the excessive feeling of concern regarding treatment
costs and sleep disturbances in relation to treatment costs resulted in the
highest and lowest levels of financial stress, with a mean of 1.41 ± 3.08 and
standard deviation, and 1.63 ± 2.38 (Table 3). The study of the effective
factors on financial anxiety showed that there was no significant difference in
the level of anxiety of patients based on variables such as gender, marital
status and age (p>0.05). In case of having health insurance, non-insured
patients were 2.03 times more likely than those with insurance. The likelihood
of exposure to financial anxiety in the treatment costs was p=0.012 (CI:
0.1-3.98 OR=2.03). In terms of job variables, unemployed patients had 1.23
times more chance of financial anxiety and a significant difference was found
between the patients in terms of job (p = 0.043; CI: 0.13-3.05; OR=1.23). Pay
out pocket, in patients who paid more than 38% of the total cost of the
disease, had caused 2.03 times more exposure to financial anxiety, indicating
that patients’ financial anxiety increased more with increasing Pay out the
pocket, (p=0.012; CI: 0.1-3.98; OR=2.03) (Table 4).
Discussion and Conclusion
The results of the study indicate
that the relationship between pay out of pocket patients and their anxiety
levels is positive, and if the increase in direct payments exceeds 38% of total
costs, patients’ levels of anxiety increase. Patel, Kleinman’s [10] study
confirmed the correlation between low incomes in developing countries and the
risk of mental illness. Mirsamadi [11] concluded that living costs are one of
the main causes of stress in health center managers, they are fully aware that
heavier medical costs will reduce the likelihood of their therapeutic
interventions on the patient and will lead to a decline in the quality of their
health center actions [11]. Pourreza et al. [12] Stated that the adoption of
new policies on the payment of heavy costs for cancer patients, in particular
by insurance agencies, financial support from financial institutions such as
banks, or charities, the distribution of specialized cancer centers, or
Providing housing for patients who have come from distant cities, in addition
to realizing health equity indicators, can reduce the financial problems facing
cancer patients, and helps them to better overcome their own illness with no
significant anxiety risk factors changes.
Ross et al. [13], in a study
conducted in 2003 and 2004, reported about financial stress in patients with
Acute Myocardial Infarction (AMI), half of the patients reported having some
levels of financial stress while admitting to the hospital, and close One third
of patients reported having a financial stress, that these stressful conditions
led to their deterioration, increased hospitalization time, decreased patient
response to treatment interventions and increased surgical risk. Along with
this study, the increase in treatment costs has led to a worsening of the
outcomes of the disease in these patients.
One of the reasons for inducing
anxiety among people in cope with health costs is the current limitation of the
current and available financial resources of individuals, who are investigating
the impact of the status of their clients’ employment, as well as their
insurance coverage, on this. The economic conditions in developing countries
are such that most people have limited monthly income, and no amount is
considered for this treatment. Also, in these countries, the risk of developing
cardiovascular disease is higher than other countries, in other words,
developing countries have a greater role in the incidence of cardiovascular
disease worldwide, more risk factors, and less government support. In current
study, it was concluded that the job status has a significant relationship with
patient anxiety and non-insurance patients with a higher chance of anxiety. In this
regard, Herman [14] announced in his report that health insurance should be
available to all individuals globally, as a result of protecting the patient in
unexpected circumstances and preventing the debtor from being financially
mistreated, is one of the requirements for reforming the health system in any
country.
Puccard, et al. (2005) Also noted
that individual, interpersonal, social, economic, psychological, and
environmental factors, contributed to the anxiety of the family members of the
patient hospitalized are effective factors . Particularly, various studies have
pointed to the impact of pocket payments on household income cuts [15].
Crawford [16] concluded that there is no significant relationship between age
and marital status, and stress . In the present study, the relationship between
these two variables and the level of patient anxiety was not significant. Arab
[17] state, with increasing health spending, which is more than wage increases,
more people need more welfare insurance coverage. Health insurance protects
customers, especially those with limited financial resources, or excessive need
for health services. Bakar [18] also state that the amount of pay out of pocket
costs is one of the factors influencing the decision to buy insurance from
stateless people. In this regard, the present study confirms that patients
without insurance coverage have anxiety more than those who have insurance
coverage.
Therefore, the high cost of treatment
in cardiovascular diseases leads to anxiety in patients, anxiety during the
hospitalization period, an increase in the length of the hospitalization
period, a decrease in the effectiveness of the results of interventions in
patients and an increase in mortality rates in these patients. On the other
hand, with the improvement in treatment costs, the reduction in community
anxiety reduces the incidence of various diseases, including cardiovascular
disease [19]. Therefore, government support for treatment costs is a form of
economic investment in the health system of the country, and governments are
advised to support healthcare costs. Based on the results, it is suggested that
research be conducted in the field of patient surveys, in order to receive
comments and suggestions on how to deal with the personnel of the clearance
unit, and to declare costs by him, the appointment of a psychologist if
symptoms are manifested Anxiety in patients, and promotion of solutions to the
ill-health of patients who do not have adequate insurance coverage, in addition
to ensuring the health of patients, also their mental health during discharge.
Acknowledgements
We would like to thank the
participants for their participation and invaluable contribution to this study.
Compliance with Ethical Standards
Ethical Approval
All procedures followed were in
accordance with ethical standards of the responsible committees on human
experimentation and with the Helsinki Declaration of 1975 and its later
amendments or comparable ethical standards. This study was a survey and verbal
consent was obtained from all participants for completing the questionnaires
For more Lupine Publishers Open Access Journals Please visit our website: https://lupinepublishersgroup.com/
For more Food And Nutrition Please Click
Here: https://lupinepublishers.com/food-and-nutri-journal/
To Know more Open Access Publishers Click on Lupine Publishers
Follow on Linkedin : https://www.linkedin.com/company/lupinepublishers
Follow on Twitter : https://twitter.com/lupine_online
No comments:
Post a Comment