{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T12:01:58Z","timestamp":1780315318502,"version":"3.54.1"},"reference-count":39,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Joint Committee\u2019s Innovation Fund","award":["01VSF19046"],"award-info":[{"award-number":["01VSF19046"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis Journal - Experimental, Translational and Clinical"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Previous investigations of multiple sclerosis (MS)-related healthcare have focused on utilisation of specific individual health services (e.g. hospital care, office-based neurologists) by people with MS (PwMS). Meanwhile, little is known about possible patterns of utilisation across health services and their potential differences across patient characteristics. <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> To comprehensively analyse and identify patterns of MS-related health service utilisation and detect patient characteristics explaining such patterns. <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> In 2021, we invited all PwMS insured by the largest insurance company in Lower Saxony, Germany, to take part in an online survey. We merged respondents\u2019 survey and health insurance claims data. We analysed MS-related health service utilisation and defined individual characteristics for subgroup analyses based on Andersen's Behavioural Model. We executed non-parametric missing value imputation and conducted hierarchical clustering to find patterns in health service utilisation. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> Of 6928 PwMS, 1935 responded to our survey and 1803 were included in the cluster analysis. We identified four distinct health service utilisation clusters: (1) regular users (n = 1130), (2) assistive care users (n = 443), (3) low users (n = 195) and (4) special services users (n = 35). Clusters differ by patient characteristics (e.g. age, impairment). <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> Our findings highlight the complexity of MS-related health service utilisation and provide relevant stakeholders with information allowing them to tailor healthcare planning according to utilisation patterns. <\/jats:p><\/jats:sec>","DOI":"10.1177\/20552173241260151","type":"journal-article","created":{"date-parts":[[2024,6,20]],"date-time":"2024-06-20T10:34:15Z","timestamp":1718879655000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Subgroup analyses and patterns of multiple sclerosis health service utilisation: A cluster analysis"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7508-0840","authenticated-orcid":false,"given":"Lara Marleen","family":"Fricke","sequence":"first","affiliation":[{"name":"Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany"},{"name":"Center for Health Economics Research Hannover (CHERH), Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Kr\u00fcger","sequence":"additional","affiliation":[{"name":"Hannover Medical School, Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover, Germany"},{"name":"Center for Health Economics Research Hannover (CHERH), Hannover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corinna","family":"Trebst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Levke","family":"Br\u00fctt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise-Marie","family":"Dilger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerstin","family":"Eichst\u00e4dt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Flachenecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"Grau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Hemmerling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyon","family":"Hoekstra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Schaubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5308-105X","authenticated-orcid":false,"given":"Alexander","family":"Stahmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jona Theodor","family":"Stahmeyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annett","family":"Thiele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe Klaus","family":"Zettl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fedor","family":"Heidenreich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Krauth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,6,20]]},"reference":[{"key":"bibr1-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/1352458520970841"},{"key":"bibr2-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103534"},{"key":"bibr3-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1111\/ene.13819"},{"key":"bibr4-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/1352458508094884"},{"key":"bibr5-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1159\/000488799"},{"key":"bibr6-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1007\/s40120-019-00172-5"},{"key":"bibr7-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31280-1"},{"key":"bibr8-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/13524585221081985"},{"key":"bibr9-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0259855"},{"key":"bibr10-20552173241260151","doi-asserted-by":"publisher","DOI":"10.2307\/2137284"},{"key":"bibr11-20552173241260151","first-page":"33","volume-title":"Changing the U.S. Health care system: key issues in health services policy and management","author":"Andersen RM","year":"2013","edition":"4"},{"key":"bibr12-20552173241260151","volume":"9","author":"Babitsch B","year":"2012","journal-title":"Psychosoc Med"},{"key":"bibr13-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2015.05.010"},{"key":"bibr14-20552173241260151","unstructured":"Presse- und Politikportal der AOK. Die AOK-Gemeinschaft: AOK Niedersachsen, https:\/\/www.aok.de\/pp\/gemeinschaft\/ (2024, accessed 28 March 2024)."},{"key":"bibr15-20552173241260151","unstructured":"LimeSurvey GmbH. LimeSurvey: An Open Source survey tool. Hamburg, Germany."},{"key":"bibr16-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2016.01.007"},{"key":"bibr17-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0066127"},{"key":"bibr18-20552173241260151","first-page":"35","volume-title":"Measures in health psychology: a user\u2019s portfolio. Causal and control beliefs","author":"Schwarzer R","year":"1995"},{"key":"bibr19-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0186516"},{"key":"bibr20-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.45.2.251"},{"key":"bibr21-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90171-8"},{"key":"bibr22-20552173241260151","unstructured":"R Core Team. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing, 2023."},{"key":"bibr23-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/1094428114548590"},{"key":"bibr24-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btr597"},{"key":"bibr25-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-07426-9"},{"key":"bibr26-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-08987-z"},{"key":"bibr27-20552173241260151","first-page":"361","volume":"2016","author":"Zayas CE","year":"2016","journal-title":"Proc Int Fla AI Res Soc Conf"},{"key":"bibr28-20552173241260151","unstructured":"Maechler M, Rousseeuw P, Struyf A, et al. cluster: Cluster Analysis Basics and Extensions, 2022."},{"key":"bibr29-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1093\/abm\/kaad008"},{"key":"bibr30-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-642-23780-5_13"},{"key":"bibr31-20552173241260151","unstructured":"Mangiafico S. rcompanion: functions to support extension education program evaluation, 2023."},{"key":"bibr32-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"bibr33-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/1352458510367721"},{"key":"bibr34-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1111\/nep.13706"},{"key":"bibr35-20552173241260151","unstructured":"GKV-Spitzenverband. Zahlen und Grafiken: Versicherte je System, https:\/\/www.gkv-spitzenverband.de\/service\/zahlen_und_grafiken\/zahlen_und_grafiken.jsp (2024, accessed 28 March 2024)."},{"key":"bibr36-20552173241260151","volume":"83","author":"Epping J","year":"2021","journal-title":"Gesundheitswesen"},{"key":"bibr37-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2021.103326"},{"key":"bibr38-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234876"},{"key":"bibr39-20552173241260151","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517708141"}],"container-title":["Multiple Sclerosis Journal - Experimental, Translational and Clinical"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173241260151","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552173241260151","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552173241260151","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T03:06:37Z","timestamp":1738033597000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552173241260151"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":39,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1177\/20552173241260151"],"URL":"https:\/\/doi.org\/10.1177\/20552173241260151","relation":{},"ISSN":["2055-2173","2055-2173"],"issn-type":[{"value":"2055-2173","type":"print"},{"value":"2055-2173","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4]]},"article-number":"20552173241260151"}}