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Samwiri Nkambule E, Msiska G. Chronic illness experience in the context of resource-limited settings: a concept analysis. Int J Qual Stud Health Well-being 2024; 19:2378912. [PMID: 39007854 PMCID: PMC11251436 DOI: 10.1080/17482631.2024.2378912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 07/08/2024] [Indexed: 07/16/2024] Open
Abstract
AIM This review describes the ways in which individuals experience chronic illnesses in resource-limited settings; to define the concept and understand its attributes, antecedents and consequences. METHODS A comprehensive analysis of the databases CINAHL, PubMed and Google Scholar was conducted. During literature search the following limits were applied: articles published in English with available full-text; articles that focused on living with chronic illness in adults from the patient's perspective. RESULTS The following three attributes of chronic illness experience were identified: transformational experience, acceptance and self-management. Prominent predisposing factors (antecedents) were: genetic inheritance, malnutrition and poverty, high levels of stress and unhealthy lifestyle. The most dominant consequences were as follows: impact on quality of life; self-management burden; burden to others and economic stressors. CONCLUSIONS The findings underscore the need for health-care professionals to understand the chronic illness experience in the context of resource-limited settings and its consequences. The greater insights into the concept of chronic illness experience in resource-limited settings will guide nurses to support people in the realities of chronic illness experience in resource-limited settings in developing countries. This knowledge can guide nurses in providing competent care to chronically ill individuals, including meeting their individual needs with such illnesses.
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Affiliation(s)
| | - Gladys Msiska
- School of Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
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Kim S, Perry LM, Mossman B, Dunn A, Hoerger M. Financial burden and physical and emotional quality of life in COPD, heart failure, and kidney failure. PLoS One 2024; 19:e0306620. [PMID: 38968278 PMCID: PMC11226075 DOI: 10.1371/journal.pone.0306620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 06/20/2024] [Indexed: 07/07/2024] Open
Abstract
Patients with chronic and serious illnesses experience significant quality of life concerns. More research is needed to understand the impact of financial burden on patients with COPD, heart failure, and kidney failure. Patients with COPD, heart failure, or kidney failure completed a cross-sectional online survey using validated measures of financial burden (general financial strain as well as financial toxicity attributable to treatment), physical quality of life (symptom burden and perceived health), and emotional quality of life (anxiety, depression, and suicidal ideation). ANCOVA was used to examine whether financial strain and financial toxicity were associated with physical and emotional quality of life, while accounting for key covariates. Among 225 participants with COPD (n = 137), heart failure (n = 48), or kidney failure (n = 40), 62.2% reported general financial strain, with 34.7% experiencing financial toxicity attributable to treatments. Additionally, 68.9% rated their health as fair or poor, experiencing significant symptom burden including fatigue, dyspnea, and chest pain. Participants also reported clinically relevant levels of anxiety (55.1%), depression (52.0%), and suicidal ideation (21.8%). In the total sample, financial strain was associated with worse physical and emotional quality of life on all measures (all Ps < .001). Financial toxicity attributable to treatment was not associated with quality of life in the total sample or subsamples. Patients with COPD, heart failure, and kidney failure face significant financial, physical, and emotional burdens. Financial strain appears to undermine physical and emotional quality of life. Our study highlights the demand for interventions aimed at mitigating financial strain and toxicity experienced by individuals with chronic illnesses.
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Affiliation(s)
- Seowoo Kim
- Department of Psychology, Tulane University, New Orleans, Louisiana, United States of America
| | - Laura M. Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center for Health Outcomes, Implementation, and Community-Engaged Science, Tulane University School of Medicine, New Orleans, Louisiana, United States of America
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, United States of America
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, United States of America
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, United States of America
- Department of Psychiatry and Medicine, Tulane Cancer Center, and A.B. Freeman School of Business, Tulane University, New Orleans, Louisiana, United States of America
- Department of Palliative and Supportive Medicine, University Medical Center, New Orleans, Louisiana, United States of America
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Hu Y, Callander E. Long-Term Effect of Having a Child at Risk of Developmental Delays on Parental Labor Force Participation. Matern Child Health J 2024; 28:1052-1060. [PMID: 38334864 PMCID: PMC11058796 DOI: 10.1007/s10995-024-03897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE This study aimed to examine the long-term influence of having a child at risk of different developmental delays (communication, mobility, self-care, relating, learning, coping, or behaving) on parental labor force participation as the child grows. METHOD A retrospective cohort was conducted using data from the Longitudinal Study of Australian Children survey, Waves 1-8 covering birth to 15 years of age of children. Multivariable logistic regressions were used to explore the odds ratio of mothers being out of the labor force at different children's ages. Cox proportional hazards models were utilized to identify the 'risk' of mothers returning to the workforce after leaving. All models were adjusted for the mother's age, education attainment, and employment status at time of birth, as well as marital status at the current wave. RESULTS There were 5,107 records of children, and 266 of them were at risk of any developmental delays at age 4-5 years. This sample represents 243, 026 children born in Australia in 2003/04. After adjusting for potential confounders, mothers of children at risk of each type of developmental delay (except mobility and self-care) had greater odds of being out of, and not returning to the labor force from children aged 2-3 to 14-15 years, when compared to mothers of children who are not at risk of developmental delays. Similar differences were found for fathers but were distinctly small and with narrower fluctuations, compared to mothers. CONCLUSION Policies and programs funded by the government are greatly needed to support the mothers of children at risk of developmental delays.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- University of Technology Sydney, Building 10, Level 8, Room 109 235-253 Jones Street, Ultimo, NSW, 2007, Australia.
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Kriaa A, Mariaule V, De Rudder C, Jablaoui A, Sokol H, Wilmes P, Maguin E, Rhimi M. From animal models to gut-on-chip: the challenging journey to capture inter-individual variability in chronic digestive disorders. Gut Microbes 2024; 16:2333434. [PMID: 38536705 PMCID: PMC10978023 DOI: 10.1080/19490976.2024.2333434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Chronic digestive disorders are of increasing incidence worldwide with expensive treatments and no available cure. Available therapeutic schemes mainly rely on symptom relief, with large degrees of variability in patients' response to such treatments, underlining the need for new therapeutic strategies. There are strong indications that the gut microbiota's contribution seems to be a key modulator of disease activity and patients' treatment responses. Hence, efforts have been devoted to understanding host-microbe interactions and the mechanisms underpinning such variability. Animal models, being the gold standard, provide valuable mechanistic insights into host-microbe interactions. However, they are not exempt from limitations prompting the development of alternative methods. Emerging microfluidic technologies and gut-on-chip models were shown to mirror the main features of gut physiology and disease state, reflect microbiota modification, and include functional readouts for studying host responses. In this commentary, we discuss the relevance of animal models in understanding host-microbe interactions and how gut-on-chip technology holds promises for addressing patient variability in responses to chronic digestive disease treatment.
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Affiliation(s)
- Aicha Kriaa
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
| | - Vincent Mariaule
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
| | - Charlotte De Rudder
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Amin Jablaoui
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
| | - Harry Sokol
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
- INSERM UMRS-938, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Sorbonne Université, Paris, France
| | - Paul Wilmes
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
- Department of Life Sciences and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Emmanuelle Maguin
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
| | - Moez Rhimi
- Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
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Peacocke EF, Fusheini A, Norris P. Community pharmacists' views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation. J Pharm Policy Pract 2023; 16:156. [PMID: 38012721 PMCID: PMC10680315 DOI: 10.1186/s40545-023-00673-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND In many countries the community pharmacist's role includes collecting prescription medicine co-payments at the point of dispensing. This is a context which can provide unique insights into individuals' access to prescription medicines, as interactions with service users about out-of-pocket (OOP) expenses that may negatively affect a pharmacist's patient counselling role. Prior research has identified that OOP expenses for prescription medicines led to decreased treatment adherence. This study aims to understand the role of community pharmacists in the collection of co-payments for prescription medicines in one region of Aotearoa New Zealand, and the possible implications for equitable access to medicines. METHODS This is a qualitative study using a case study research design. Data were collected through focus groups, individual interviews, and an electronic survey. Using a critical realist approach in thematic analysis, findings were categorised as Causal tendencies (the things that cause the events); Events (the things that community pharmacists experience); and Experiences (the perceptions and feelings of individual participants). RESULTS Our analysis finds that the current profession of community pharmacy in Aotearoa New Zealand, is under strain. The results suggest that broader government policies, such as the pharmacist's role in delivering essential health services, the fairness of standard prescription co-payments, and the role of community pharmacists as gatekeepers, have a significant influence on the profession. In addition, the study found that individual community pharmacists have a unique position in the co-payment process, face power imbalances within their role, and the study indicates evidence of value judgements towards service users. CONCLUSIONS This study is exploratory; however, its examination of the policy of prescription medicine co-payments from the perspective of community pharmacists, who play a vital role in both dispensing medicines and collecting prescription medicine co-payments, is novel. Despite prescription medicine co-payments being a routine part of pharmacists' role in many countries, it is a topic where there is limited published peer-reviewed literature. The study adds to existing evidence that funding models influence community pharmacists' role. In addition, this study identified value judgements about service users in relation to prescription medicine co-payments which may influence service users' health-seeking behaviour. In this setting, limited representation of at-risk populations in the community pharmacy profession may be a factor that negatively influence interactions between pharmacists and service users.
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Affiliation(s)
- Elizabeth F Peacocke
- Norwegian Institute of Public Health, Skøyen, P.O. Box 222, 0213, Oslo, Norway.
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
| | - Adam Fusheini
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- Va'a o Tautai, Centre for Pacific Health, University of Otago, Dunedin, New Zealand
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Lisipeki S, Masters-Awatere B, Hodgetts D, Liew TV. Reciprocal relations between cardiovascular disease, employment, financial insecurity, and post cardiac event recovery among Māori men: a case series. J Med Case Rep 2023; 17:468. [PMID: 37951947 PMCID: PMC10640749 DOI: 10.1186/s13256-023-04202-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/04/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men's access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded. METHODS This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1-3-hour interviews recorded with participants (12 interviews); the first interviews took place 5-16 weeks after surgery/discharge. RESULTS Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity-as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery. CONCLUSION Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively.
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Affiliation(s)
| | | | - Darrin Hodgetts
- School of Psychology, Massey University, Albany, New Zealand.
| | - Tze Vun Liew
- Te Whatu Ora Waikato District, Hamilton, New Zealand
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Sultana N, Rahman MM, Khanam R, Rayhan I, Hossain R. Food insecurity and health outcome nexus: empirical evidence from the informal sector enterprises in Bangladesh. BMC Public Health 2023; 23:722. [PMID: 37081468 PMCID: PMC10116455 DOI: 10.1186/s12889-023-15655-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Food insecurity indicates the difficulty of constantly obtaining adequate food because of limited economic resources. Food insecurity challenges the desired health outcomes. Although extensive literature has examined the associations between food security and health, low-wage informal sector workers have been less frequently addressed in this topic. The present study has focused on food insecurity among the workers working in the informal sector enterprises who experienced entrenched disadvantage during COVID-19 and examines the relationship between food insecurity and health status as measured by self-reported physical and mental health conditions. METHODS This study has utilized cross-sectional data collected from workers working in informal manufacturing and business enterprises in Dhaka city of Bangladesh. The Food Insecurity Experience Scale (FIES) with eight items is used to screen for food insecurity, and the Short Form 12v2 (SF12v2) scale with 12 questions, and validated for use with Bengali respondents, is used to measure the health status of the informal workers. A health production function has been constructed where the health status (both physical and mental) of workers is associated with food insecurity and other socio-economic and health care factors. Empirical analyses of the study have included descriptive statistics, mean score comparisons, and multivariate regression analyses to identify the predictive factors of the physical and mental health status of the workers. RESULTS A moderate to severe food insecurity is found to be responsible for the poor health status (both physical and mental) of the selected working group population. Moreover, age over 40 years, having a large family, dissatisfaction with the work place, and the prevalence of occupational health risks are linked to lower physical health, while dissatisfaction with the work place and the incidence of severe diseases contribute to poor mental health status along with food insecurity. CONCLUSIONS Extending social and economic protection towards health coverage and basic consumption is suggested as an immediate action to save lives and ensure productivity of the informal workers. Besides, an increase in income and ensuring decent working conditions are also recommended for the health, safety and satisfaction of workers working in informal sector enterprises.
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Affiliation(s)
- Nahid Sultana
- School of Business, University of Southern Queensland, Toowoomba, Australia.
- Department of Economics, Jahangirnagar University, Savar, Bangladesh.
| | | | - Rasheda Khanam
- School of Business, University of Southern Queensland, Toowoomba, Australia
| | - Istihak Rayhan
- Department of Economics, Jahangirnagar University, Savar, Bangladesh
| | - Roni Hossain
- Department of Economics, Jahangirnagar University, Savar, Bangladesh
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Larkin J, Walsh B, Moriarty F, Clyne B, Harrington P, Smith SM. What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. BMJ Open 2022; 12:e060502. [PMID: 36581975 PMCID: PMC9438209 DOI: 10.1136/bmjopen-2021-060502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Individuals with multimorbidity use more health services and take more medicines. This can lead to high out-of-pocket (OOP) healthcare expenditure. This study, therefore, aimed to assess the association between multimorbidity (two or more chronic conditions) and OOP healthcare expenditure in a nationally representative sample of adults aged 50 years or over. DESIGN Cross-sectional analysis of data collected in 2016 from wave 4 of The Irish Longitudinal Study on Ageing.SettingIreland.ParticipantsCommunity-dwelling adults aged 50 years and over.MethodA generalised linear model with log-link and gamma distributed errors was fitted to assess the association between multimorbidity and OOP healthcare expenditure (including general practitioner, emergency department, outpatients, specialist consultations, hospital admissions, home care and prescription drugs). RESULTS Overall, 3453 (58.5%) participants had multimorbidity. Among those with any OOP healthcare expenditure, individuals with multimorbidity spent more on average per annum (€806.8 for two conditions, €885.8 for three or more conditions), than individuals with no conditions (€580.3). Pharmacy-dispensed medicine expenditure was the largest component of expenditure. People with multimorbidity on average spent more of their equivalised household income on healthcare (7.1% for two conditions, 9.7% for three or more conditions), than people with no conditions (5.0%). A strong positive association was found between number of conditions and OOP healthcare expenditure (p<0.001) and between having private health insurance and OOP healthcare expenditure (p<0.001). A strong negative association was found between eligibility for free primary/hospital care and heavily subsidised medicines and OOP healthcare expenditure (p<0.001). CONCLUSIONS This study suggests that having multimorbidity in Ireland increases OOP healthcare expenditure, which is problematic for those with more conditions who have lower incomes. This highlights the need for this financial burden to be considered when designing healthcare/funding systems to address multimorbidity, so that access to essential healthcare can be maximised for those with greatest need.
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Affiliation(s)
- James Larkin
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Brendan Walsh
- Social Research Division, The Economic and Social Research Institute, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Patricia Harrington
- Health Technology Assessment Directorate, Health Information and Quality Authority, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin 2, Ireland
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Sujan MH, Tasnim R, Islam MS, Ferdous M, Haghighathoseini A, Koly KN, Pardhan S. Financial hardship and mental health conditions in people with underlying health conditions during the COVID-19 pandemic in Bangladesh. Heliyon 2022; 8:e10499. [PMID: 36060462 PMCID: PMC9428118 DOI: 10.1016/j.heliyon.2022.e10499] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/05/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022] Open
Abstract
Background Financial hardship is a major concern for patients who are suffering from long-term underlying health conditions. It is likely that emergencies such as the COVID-19 pandemic would impose increased financial distress and lead to the development or exacerbation of mental health conditions. Objective The present study aimed to explore the relationship between financial hardship and mental health conditions (loneliness, anxiety, and depression) among patients with underlying health conditions in Bangladesh. Methods An e-survey based cross-sectional study was conducted among purposively selected 971 patients (50.1% male; mean age = 42.29 [SD = 15.86]) with underlying health conditions between November 2020 and January 2021. Depression, anxiety, and loneliness were measured using the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and UCLA loneliness scale, respectively. Multiple logistic regression analyses were performed to determine any associations between financial hardship and mental health conditions (loneliness, anxiety, and depression). Results 46.2% of participants reported experiencing financial difficulties, and a number of respondents (12.3%) had lost their jobs during the COVID-19 pandemic. The prevalence of anxiety, depression and loneliness were 35.2%, 38.9%, and 47.68%, respectively. In the multiple logistic regression analysis, age, gender, occupation, marital status, monthly income, self-reported health status and financial hardship were significantly associated with mental health conditions. Conclusions Mental health problems were prevalent among people with underlying health conditions and were also associated with financial difficulties. The findings suggest that care facilities should be strengthened by including psychosocial support components delivered with lower costs, particularly for patients with underlying health conditions.
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Affiliation(s)
- Md.Safaet Hossain Sujan
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
- Corresponding author.
| | - Rafia Tasnim
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
- Corresponding author.
| | - Md. Saiful Islam
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka-1342, Bangladesh
- Corresponding author.
| | - Most.Zannatul Ferdous
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh
| | | | - Kamrun Nahar Koly
- Health System and Population Studies Division, icddr,b, Mohakhali, Dhaka-1212, Bangladesh
| | - Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge UK
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Darley A, Dix R, Rocher E, Stokes D, Carroll Á. Older adults and family caregivers’ experience of digital health technology in frailty care: A systematic review and meta-ethnography protocol. HRB Open Res 2022; 5:38. [PMID: 36072817 PMCID: PMC9391740 DOI: 10.12688/hrbopenres.13549.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Digital health technology has been identified as a valuable tool to support older adults with frailty needs in their home setting. Despite the numerous technologies and evaluations of these innovations, a synthesis of the older person and family caregivers’ experience using technology for support self-management has not been conducted to date. Methods and analysis: A systematic review and meta-ethnography will be conducted in accordance with the PRISMA and eMERGe reporting guidelines. Four peer-reviewed empirical evidence databases will be searched (Medline (Ovid), CINAHL, EMBASE, PsycINFO) using a defined search strategy. Studies containing qualitative data on the experiences of older people or family caregivers of using digital health technology to support frailty care will be included. Covidence software will be used to screen studies and extract data. The Critical Appraisal Skills Programme (CASP) checklist for qualitative research will be used by two independent reviewers to appraise all included papers. A meta-ethnography will be undertaken in accordance with the seven-phase method described by Noblit and Hare: (1) Getting started, (2) Deciding what is relevant to the initial interest, (3) Reading the studies, (4) Determining how the studies are related, (5) Translating the studies into one another, (6) Synthesizing translations and (7) Expressing the synthesis. Discussion: To the best of our knowledge, this will be the first systematic review to integrate and synthesize the findings of qualitative studies of older citizens’ experience of digital health technology. The findings of this meta-ethnography will endeavour to inform future research, policy and clinical practice. In particular, the results will help to inform the design of future digital health technology to meet the needs of older adults. PROSPERO registration number: CRD42022314608.
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Affiliation(s)
- Andrew Darley
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | | | - Diarmuid Stokes
- Health Sciences Library, University College Dublin, Dublin, Ireland
| | - Áine Carroll
- School of Medicine, University College Dublin, Dublin, Ireland
- The National Rehabilitation Hospital (NRH), Dublin, Ireland
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Hu Y, Carr PR, Liew D, Broder J, Callander EJ, McNeil JJ. How does the onset of physical disability or dementia in older adults affect economic wellbeing and co-payments for health care? the impact of gender. BMC Health Serv Res 2022; 22:701. [PMID: 35614437 PMCID: PMC9131631 DOI: 10.1186/s12913-022-08017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/27/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Existing studies have illustrated how the onset of physical disability or dementia negatively impacts economic wellbeing and increases out of pocket costs. However, little is known about this relationship in older individuals. Consequently, this study aimed to identify how the onset of physical disability or dementia in older adults affects economic wellbeing and out of pocket costs, and to explore the impact of gender in the context of Australia. METHODS The data was collected from a large, randomized clinical study, ASPirin in Reducing Events in the Elderly (ASPREE). Two generalized linear models (with and without interaction effects) of total out of pocket costs for those who did and did not develop physical disability or dementia were generated, with adjustment for sociodemographic characteristics at baseline. RESULTS We included 8,568 older Australian individuals with a mean age of 74.8 years and 53.2% being females. After adjustment for the baseline sociodemographic characteristics, the onset of physical disability did statistically significantly raise out of pocket costs (cost ratio = 1.25) and costs among females were 13.1% higher than males. CONCLUSIONS This study highlights that classifying different types of health conditions to identify the drivers of out of pocket costs and to explore the gender differences in a long-term follow-up is of importance to examine the financial impact on the older population. These negative financial impacts and gender disparities of physical disability and dementia must be considered by policymakers.
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Affiliation(s)
- Yanan Hu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Prudence R. Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily J. Callander
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Darley A, Dix R, Rocher E, Stokes D, Carroll Á. Older adults and family caregivers’ experience of digital health technology in frailty care: A systematic review and meta-ethnography protocol. HRB Open Res 2022; 5:38. [DOI: 10.12688/hrbopenres.13549.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Digital health technology has been identified as a valuable tool to support older adults with frailty needs in their home setting. Despite the numerous technologies and evaluations of these innovations, a synthesis of the older person and family caregivers’ experience using technology for support self-management has not been conducted to date. Methods and analysis: A systematic review and meta-ethnography will be conducted in accordance with the PRISMA and eMERGe reporting guidelines. Four peer-reviewed empirical evidence databases will be searched (Medline (Ovid), CINAHL, EMBASE, PsycINFO) using a defined search strategy. Studies containing qualitative data on the experiences of older people or family caregivers of using digital health technology to support frailty care will be included. Covidence software will be used to screen studies and extract data. The Critical Appraisal Skills Programme (CASP) checklist for qualitative research will be used by two independent reviewers to appraise all included papers. A meta-ethnography will be undertaken in accordance with the seven-phase method described by Noblit and Hare: (1) Getting started, (2) Deciding what is relevant to the initial interest, (3) Reading the studies, (4) Determining how the studies are related, (5) Translating the studies into one another, (6) Synthesizing translations and (7) Expressing the synthesis. Discussion: To the best of our knowledge, this will be the first systematic review to integrate and synthesize the findings of qualitative studies of older citizens’ experience of digital health technology. The findings of this meta-ethnography will endeavour to inform future research, policy and clinical practice. In particular, the results will help to inform the design of future digital health technology to meet the needs of older adults. PROSPERO registration number: Submitted 05/04/2022 and currently under review.
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Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res 2022; 22:427. [PMID: 35361215 PMCID: PMC8973527 DOI: 10.1186/s12913-022-07816-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions. Methods A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis. Results The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects. Conclusions The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07816-7.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Fracso D, Bourrel G, Jorgensen C, Fanton H, Raat H, Pilotto A, Baker G, Pisano MM, Ferreira R, Valsecchi V, Pers YM, Engberink AO. The chronic disease Self-Management Programme: A phenomenological study for empowering vulnerable patients with chronic diseases included in the EFFICHRONIC project. Health Expect 2022; 25:947-958. [PMID: 35014112 PMCID: PMC9122418 DOI: 10.1111/hex.13430] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/14/2021] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction The Chronic Disease Self‐Management Programme (CDSMP) has resulted in improved health outcomes for patients. However, research has focused mainly on those with chronic conditions and has not extensively explored prevention programmes targeting individuals with specific vulnerability profiles. Aim This study aimed to understand the effects of the CDSMP on the lived experience of vulnerable patients included in the EFFICHRONIC project in France, based on their needs and expectations before and after participation. Methods We conducted a qualitative phenomenological semio‐pragmatic study based on 37 in‐depth interviews with 20 patients (20 before/17 after CDSMP). Results By transforming existential dimensions (identity, relationship with others and bodily experience), chronic illness generates new needs in the vulnerable person. By resonating with the expectations and needs of participants, the CDSMP induces motivation and a sense of belonging to a community of peers. It has enabled the participants to become actors of their own health until empowerment. Although some limitations are reported, the programme has awakened a desire in the participants to take better care of their health and to develop personal skills with, for some, a desire to become involved in health education. Conclusion Our phenomenological approach highlighted the resonance between the programme (its design and implementation) and the lived experience of patients, as an effective element of empowerment. This necessitates training the facilitators to elicit the lived experience of patients. Furthermore, as a patient‐centred approach is required, the facilitators need to learn how to adapt the design of the programme to the singularity of the patient. Patient or Public Contribution Patients provided the data that were collected through in‐depth interviews, and their experiences before and after the programme were analysed.
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Affiliation(s)
- Dallal Fracso
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France.,Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Gérard Bourrel
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Hélène Fanton
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alberto Pilotto
- Department of Geriatric Care, Orthogeriatrics and Rehabilitation, E.O. Galliera Hospital, Genoa, Italy
| | - Graham Baker
- Quality Institute for Self Management Education and Training, Portsmouth, UK
| | - Marta M Pisano
- General Direction of Care, Humanization and Social and Health Care, Ministry of Health, Biosanitary Research Institute of the Principality of Asturias, Asturias, Spain
| | - Rosanna Ferreira
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, INSERM, CHU Montpellier, University of Montpellier, Montpellier, France
| | - Agnes Oude Engberink
- Department of Primary Care, School of Medicine, University of Montpellier, Montpellier, France.,Institut Desbrest d'Epidémiologie et de Santé Public, UMR UA11 INSERM, Université de Montpellier, Montpellier, France
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15
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Coleman W, Spencer D, Wong P, Manolios N. An enquiry into the crippling gout affecting Pacific Islander and Māori men in Western Sydney. Int J Rheum Dis 2021; 24:1394-1401. [PMID: 34611996 DOI: 10.1111/1756-185x.14222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
AIM Despite the effectiveness and availability of urate-lowering therapies (ULT), we continue to see a number of advanced cases of tophaceous gout in the Pacific Islander and Māori population in Western Sydney. Although the high prevalence and increased severity of gout in this cohort has been well documented, there has been little qualitative research undertaken in Australia into the lived experience of this group of people. It is this gap in the research that our study aimed to address. METHODS Participants were recruited from the rheumatology clinics at Westmead and Blacktown Hospitals. Those eligible to participate were Pacific Islander and Māori patients with tophaceous gout currently living in the Western Sydney Local Health District (WSLHD). Data collection took the form of 10 semi-structured interviews, which were subsequently transcribed verbatim. A thematic analysis of the data was then performed. RESULTS Thematic analysis identified 6 key themes: lack of understanding of the disease and its potential effects; missed opportunities for intervention and disjointed care; chronic reliance upon corticosteroids; trivialization of gout as a nuisance illness; the substantial financial impact of chronic illness; and the all-consuming nature of severe gout. CONCLUSION The human cost of severe tophaceous gout in this cohort is immense. All 10 participants exemplified the disease's devastating social effects. We propose 4 key recommendations: improved education regarding diagnosis and management; immediate prescription of ULT at first presentation; a lower threshold for out-of-hospital rheumatologist referral; and improved follow-up through a nurse- and pharmacist-led collaborative gout management program.
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Affiliation(s)
- William Coleman
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - David Spencer
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
| | - Peter Wong
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia.,Rural Clinical School Coffs Harbour Campus, The University of New South Wales, Sydney, NSW, Australia
| | - Nicholas Manolios
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Rheumatology, Westmead Hospital, Sydney, NSW, Australia
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16
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Ng MSN, Chan DNS, Cheng Q, Miaskowski C, So WKW. Association between Financial Hardship and Symptom Burden in Patients Receiving Maintenance Dialysis: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189541. [PMID: 34574463 PMCID: PMC8464840 DOI: 10.3390/ijerph18189541] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients on maintenance dialysis experience financial hardship. Existing studies are mainly cost analyses that quantify financial hardship in monetary terms, but an evaluation of its impact is also warranted. This review aims to explore the definition of financial hardship and its relationship with symptom burden among patients on dialysis. METHODS A literature search was conducted in November 2020, using six electronic databases. Studies published in English that examined the associations between financial hardship and symptom burden were selected. Two reviewers independently extracted data and appraised the studies by using the JBI Critical Appraisal Checklists. RESULTS Fifty cross-sectional and seven longitudinal studies were identified. Studies used income level, employment status, healthcare funding, and financial status to evaluate financial hardship. While relationships between decreased income, unemployment, and overall symptom burden were identified, evidence suggested that several symptoms, including depression, fatigue, pain, and sexual dysfunction, were more likely to be associated with changes in financial status. CONCLUSION Our findings suggest that poor financial status may have a negative effect on physical and psychological well-being. However, a clear definition of financial hardship is warranted. Improving this assessment among patients on dialysis may prompt early interventions and minimize the negative impact of financial hardship.
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Affiliation(s)
- Marques Shek Nam Ng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Dorothy Ngo Sheung Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
- Correspondence: ; Tel.: +852-3943-8165
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA 94143, USA;
| | - Winnie Kwok Wei So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (M.S.N.N.); (Q.C.); (W.K.W.S.)
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Rachev B, Uyei J, Singh R, Kowal S, Johnson CE. Stakeholder point of view on prescription drug affordability - a systematic literature review and content analysis. Health Policy 2021; 125:1158-1165. [PMID: 34281700 DOI: 10.1016/j.healthpol.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of this research were to: 1) understand perspectives on affordability of pharmaceutical drugs from the point of view of stakeholders as reported in published peer-reviewed journals and conferences; 2) evaluate if (and how) perspectives on affordability overlapped across stakeholders. METHODS The systematic literature review followed Cochrane and PRISMA guidelines. Content analysis with iterative and systematic coding of text was conducted, to identify themes. RESULTS A total of 7,372 unique citations were eligible, and 126 articles included for final synthesis. For patients, 6 core themes emerged: financial barriers, adherence, access, patient-provider communication, financial distress, and factors that impact affordability. For payers, 5 core themes: financing schemes, cost-effectiveness, budget impact, private vs. public preferences, and ethics. For providers, 3 themes: patient-provider communication, physician prescribing behavior, and finding alternatives to support patient access. For policymakers, 2 themes: measuring affordability and the role of government. Limited articles representing the manufacturer perspective were identified. Perspectives of decision makers (payers, policymakers) did not overlap with those affected by affordability (patients, providers). CONCLUSIONS This research highlights the multi-dimensionality of drug "affordability." Multiple factors beyond cost influence patient affordability implying interventions can help alleviate affordability issues for some patients. The lack of overlap highlights potential hazards that decisions related to out-of-pocket spending, insurance coverage, reimbursement, and rationing occur without explicitly considering patient and provider perspectives.
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Affiliation(s)
| | - Jennifer Uyei
- Principal, Health Economics and Outcomes Research, IQVIA Inc., San Francisco, CA, USA
| | - Rajpal Singh
- Senior Consultant, Health Economics and Outcomes Research, IQVIA Inc., Mumbai, India
| | - Stacey Kowal
- Practice Leader, Health Economics and Outcomes Research, IQVIA Inc., Falls Church, VA, USA
| | - C Erwin Johnson
- Director, Policy Evidence Research CORE, Merck & Co. Inc., Kenilworth, NJ, USA.
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18
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Ryder C, Mackean T, Coombes J, Hunter K, Ullad S, Rogers K, Essue B, Holland AJA, Ivers R. Developing economic measures for Aboriginal and Torres Strait Islander families on out-of-pocket healthcare expenditure. AUST HEALTH REV 2021; 45:265-273. [PMID: 34016253 DOI: 10.1071/ah20299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
Objective Out-of-pocket healthcare expenditure (OOPHE) has a significant impact on marginalised households. The purpose of this study was to modify a pre-existing OOPHE survey for Aboriginal and Torres Strait Islander households with children. Methods The OOPHE survey was derived through a scoping review, face and content validity, including judgement quantification with content experts. Exploratory factor analyses determined factor numbers for construct validity. Repeatability through test-retest processes and reliability was assessed through internal consistency. Results The OOPHE survey had 168 items and was piloted on 67 Aboriginal and Torres Strait Islander parents. Construct validity assessment generated a 62-item correlation matrix with a three-factor model. Across these factors, item loadings varied, 10 items with high correlations (>0.70) and 20 with low correlations (<0.40). OOPHE survey retest was conducted with 47 families, where 43 items reached slight to fair levels of agreement. Conclusion The low level of item loadings to factors in the OOPHE survey indicates interconnectedness across the three-factor model, and reliability results suggest systemic differences. Impeding factors may include cohort homogeneity and survey length. It is unknown how cultural and social nuances specific to Aboriginal and Torres Strait Islander households impacts on results. Further work is warranted. What is known about the topic? Out-of-pocket healthcare expenditure (OOPHE) are expenses not covered by universal taxpayer-funded health insurance. In elderly Australians or those with chronic conditions, OOPHE can cause substantial burden and financial hardship and, in the most extreme cases, induce bankruptcy. Despite higher hospital admissions and disease burden, little is known about how OOPHE impacts Aboriginal and Torres Strait Islander families. Additionally, in Australia, no OOPHE survey tools have been appropriately assessed; this includes for use with Aboriginal and Torres Strait Islander families. What does this paper add? This pilot study modified a pre-existing Australian OOPHE survey for use with Aboriginal and Torres Strait Islander households with children. Knowledge interface methodology was used to bring together Indigenous knowledges with quantitative survey methods. This was critical to ensuring Indigenous knowledges were central to the overall pilot study across item creation, participant focus, outcome contextualisation, interpretation, and resetting dominant norms. Outcomes have demonstrated pertinent points for future work in this area, such as the complexities in developing robust, culturally safe and specific surveys, which reach ideal psychometric levels of validity and reliability for Aboriginal and Torres Strait Islander communities. Certainly, it raises questions for current and future research using surveys in Aboriginal and Torres Strait Islander communities, which are generic and not purpose-built. What are the implications for practitioners? We recommend that OOPHE surveys should be developed with Aboriginal and Torres Strait Islander families from the outset, so they can include important contextual factors for Aboriginal and Torres Strait Islander households.
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Affiliation(s)
- Courtney Ryder
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and Discipline of Public Health, College of Medicine Public Health, Flinders University, GPO Box 2100, SA 5001, Australia. ; ; and Corresponding author.
| | - Tamara Mackean
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and Discipline of Public Health, College of Medicine Public Health, Flinders University, GPO Box 2100, SA 5001, Australia. ;
| | - Julieann Coombes
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and The University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Kate Hunter
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ;
| | - Shahid Ullad
- Discipline of Public Health, College of Medicine Public Health, Flinders University, GPO Box 2100, SA 5001, Australia. ;
| | - Kris Rogers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and The University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Beverley Essue
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and Canadian Partnership Against Cancer Corporation, 145 King Street West, Toronto, ON M4H IJ8, Canada
| | - Andrew J A Holland
- The University of Sydney School of Medicine, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, Westmead, NSW 2145, Australia.
| | - Rebecca Ivers
- The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Road, NSW 2050, Australia. ; ; ; ; and Discipline of Public Health, College of Medicine Public Health, Flinders University, GPO Box 2100, SA 5001, Australia. ; ; and School of Public Health and Community Medicine, UNSW, Sydney, NSW 2052, Australia.
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19
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Kočiš Krůtilová V, Bahnsen L, De Graeve D. The out-of-pocket burden of chronic diseases: the cases of Belgian, Czech and German older adults. BMC Health Serv Res 2021; 21:239. [PMID: 33731090 PMCID: PMC7967967 DOI: 10.1186/s12913-021-06259-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 03/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Out-of-pocket payments have a diverse impact on the burden of those with a higher morbidity or the chronically ill. As the prevalence of chronic diseases increases with age, older adults are a vulnerable group. The paper aims to evaluate the impact of chronic diseases on the out-of-pocket payments burden of the 50+ populations in Belgium, the Czech Republic and Germany. METHODS Data from the sixth wave of the Survey of Health, Ageing and Retirement in Europe is used. A two-part model with a logit model in the first part and a generalised linear model in the second part is applied. RESULTS The diseases increasing the burden in the observed countries are heart attacks, high blood pressure, cancer, emotional disorders, rheumatoid arthritis and osteoarthritis. Reflecting country differences Parkinson's disease and its drug burden is relevant in Belgium, the drugs burden related to heart attack and outpatient care burden to chronic kidney disease in the Czech Republic and the outpatient care burden of cancer and chronic lung disease in Germany. In addition, we confirm the regressive character of out-of-pocket payments. CONCLUSIONS We conclude that the burden is not equitably distributed among older adults with chronic diseases. Identification of chronic diseases with a high burden can serve as a supplementary protective feature.
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Affiliation(s)
- Veronika Kočiš Krůtilová
- Faculty of Business and Economics, Mendel University in Brno, Zemedelska 1, 613 00, Brno, Czech Republic.
| | - Lewe Bahnsen
- Institute for Public Finance and Social Policy, Albert-Ludwigs-University of Freiburg, P.O. Box, 79085, Freiburg, Germany
| | - Diana De Graeve
- Faculty of Business and Economics, University of Antwerp, Prinsstraat 13, 2000, Antwerp, Belgium
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Clay SL, Woodson MJ, Mazurek K, Antonio B. Racial Disparities and COVID-19: Exploring the Relationship Between Race/Ethnicity, Personal Factors, Health Access/Affordability, and Conditions Associated with an Increased Severity of COVID-19. RACE AND SOCIAL PROBLEMS 2021; 13:279-291. [PMID: 33613785 PMCID: PMC7880209 DOI: 10.1007/s12552-021-09320-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 05/13/2023]
Abstract
COVID-19 was recognized as a pandemic in the United States in March 2020. Since the emergence, research has explored conditions associated with the illness; however, racial disparities remain underexplored. The purpose of this paper is to explore disparities in conditions associated with an increased severity risk of COVID-19 including race, personal factors, healthcare accessibility, and affordability. Using data from the 2018 National Health Interview Survey (NHIS), univariate and multivariate analysis were performed. More Non-Hispanic (NH) Blacks (61.1%) and NH Whites (61.2%) had conditions associated with increased severity risk of COVID-19 compared to Hispanics (47.1%) (p < .001). Racial differences revealed a higher proportion of NH Blacks with increased severity risk of COVID-19 were female (p < .001), not married (p < .001), not employed for wages (p < .001), had accessibility issues with transportation (p < .001), and had affordability issues with paying for medicine (p < .001). A higher proportion of Hispanic persons had a health place change (p = .020), had accessibility issues (e.g. telephone (p < .001), longer wait times (p < .001), closed facility (p = .038)) and had affordability issue with worrying about pay (p < .001). Significant predictors that were positively associated with increased severity risk of COVID-19 for all racial/ethnic groups were being NH Black, older age, having appointment issues, and affordability issues with medicine. Differences in magnitude across racial group dynamics were observed. Racial disparities exist in conditions associated with increased severity risk of COVID-19. As future policies and interventions are developed, it is important to consider differentials across racial group dynamics.
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Affiliation(s)
- Shondra Loggins Clay
- School of Interdisciplinary Health (SIHP), Northern Illinois University, 370 Wirtz Drive, 323D Wirtz Hall, Dekalb, IL 60115 USA
| | - Markisha J. Woodson
- Department of Public Health, College of Education and Health Services, Benedictine University, 5700 College Road, Lisle, IL 60532 USA
| | - Kathryn Mazurek
- School of Interdisciplinary Health (SIHP), Northern Illinois University, 370 Wirtz Drive, 323D Wirtz Hall, Dekalb, IL 60115 USA
| | - Beverly Antonio
- Department of Public Health, College of Education and Health Services, Benedictine University, 5700 College Road, Lisle, IL 60532 USA
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21
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Wakeel F, Njoku A. Application of the Weathering Framework: Intersection of Racism, Stigma, and COVID-19 as a Stressful Life Event among African Americans. Healthcare (Basel) 2021; 9:145. [PMID: 33540498 PMCID: PMC7912903 DOI: 10.3390/healthcare9020145] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/16/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022] Open
Abstract
The disproportionate impact of coronavirus disease 2019 (COVID-19) on African American communities necessitates an increased focus on the intersectional roles of racism, stigma, and other social determinants of health in influencing disease and mortality risk. The Weathering Framework is applied to demonstrate the dynamic interrelationships between these factors and to conceptualize COVID-19 as a stressful life event that will have profound health implications over the life course for African Americans. Recommendations for population health research, interventions and policies aimed at reducing COVID-19 incidence and mortality, and mitigation of the long-term impacts of the pandemic on communities of color are discussed.
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Affiliation(s)
- Fathima Wakeel
- College of Health, Lehigh University, 1 W. Packer Ave., STEPS Building, Room 366, Bethlehem, PA 18015, USA
| | - Anuli Njoku
- Department of Public Health, College of Health and Human Services, Southern Connecticut State University, 144 Farnham Avenue, New Haven, CT 06515, USA;
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22
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Rasmussen B, Wynter K, Rawson HA, Skouteris H, Ivory N, Brumby SA. Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review. Aust J Prim Health 2021; 27:243-254. [PMID: 34229829 DOI: 10.1071/py20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Department of Public Health, University of Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Denmark; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Helen A Rawson
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Nicola Ivory
- Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Susan A Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia; and National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia
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23
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Larkin J, Foley L, Smith SM, Harrington P, Clyne B. The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. Health Expect 2020; 24:282-295. [PMID: 33264478 PMCID: PMC8077119 DOI: 10.1111/hex.13166] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
Background Multimorbidity prevalence is increasing globally. People with multimorbidity have higher health care costs, which can create a financial burden. Objective To synthesize qualitative research exploring experience of financial burden for people with multimorbidity. Search strategy Six databases were searched in May 2019. A grey literature search and backward and forward citation checking were also conducted. Inclusion criteria Studies were included if they used a qualitative design, conducted primary data collection, included references to financial burden and had at least one community‐dwelling adult participant with two or more chronic conditions. Data extraction and synthesis Screening and critical appraisal were conducted by two reviewers independently. One reviewer extracted data from the results section; this was checked by a second reviewer. GRADE‐CERQual was used to summarize the certainty of the evidence. Data were analysed using thematic synthesis. Main results Forty‐six studies from six continents were included. Four themes were generated: the high costs people with multimorbidity experience, the coping strategies they use to manage these costs, and the negative effect of both these on their well‐being. Health insurance and government supports determine the manageability and level of costs experienced. Discussion Financial burden has a negative effect on people with multimorbidity. Continuity of care and an awareness of the impact of financial burden of multimorbidity amongst policymakers and health care providers may partially address the issue. Patient or public contribution Results were presented to a panel of people with multimorbidity to check whether the language and themes ‘resonated’ with their experiences.
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Affiliation(s)
- James Larkin
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Barbara Clyne
- HRB Centre for Primary Care, Royal College of Surgeons in Ireland, Dublin, Ireland.,Health Information and Quality Authority, Dublin, Ireland
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24
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Nedjat-Haiem FR, Cadet T, Parada H, Jones T, Jimenez EE, Thompson B, Wells KJ, Mishra SI. Financial Hardship and Health Related Quality of Life Among Older Latinos With Chronic Diseases. Am J Hosp Palliat Care 2020; 38:938-946. [PMID: 33153273 DOI: 10.1177/1049909120971829] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations. OBJECTIVE We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer. METHODS This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being). RESULTS The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being. CONCLUSION In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.
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Affiliation(s)
| | | | | | | | - Elvira E Jimenez
- 19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Beti Thompson
- 7286Fred Hutchinson Cancer Research Center, Seattle, WA, USA
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25
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Zavras D. Studying Healthcare Affordability during an Economic Recession: The Case of Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217790. [PMID: 33114353 PMCID: PMC7662360 DOI: 10.3390/ijerph17217790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022]
Abstract
The significant deterioration of economic prosperity in Greece during the economic crisis decreased patients’ ability to pay. Thus, the objective of this study is to determine the factors affecting healthcare affordability in Greece during an economic recession. This study used data from the European Union Statistics on Income and Living Conditions (EU-SILC) 2016. The sample consisted of 18,255 households. Healthcare affordability was regressed on geographic characteristics as well as several variables that refer to the households’ financial condition. Region of residence, ability to make ends meet, and capacity to cope with unexpected financial expenses were found to be statistically significant. Using sample sizes of 1000 and 1096 adults, respectively, the European Quality of Life Surveys (EQLS) of 2007 and 2016 were also used as data sources. Economic crisis was expressed with a dummy variable: (1) 0: 2007, and (2) 1: 2016. Difficulty in responding to healthcare costs was regressed on survey year and several demographic, socioeconomic, and health characteristics, revealing that individuals were more likely to face difficulties in responding to healthcare costs during the economic crisis. These results confirm the mechanism on the basis of which economic crises affect healthcare access: primarily through the effects of demand-side barriers.
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Affiliation(s)
- Dimitris Zavras
- Department of Public Health Policy, School of Public Health, University of West Attica, 11521 Athens, Greece
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26
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Crawford JO, Berkovic D, Erwin J, Copsey SM, Davis A, Giagloglou E, Yazdani A, Hartvigsen J, Graveling R, Woolf A. Musculoskeletal health in the workplace. Best Pract Res Clin Rheumatol 2020; 34:101558. [DOI: 10.1016/j.berh.2020.101558] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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Nathan N, Nguyen AD, Stocker S, Laba TL, Baysari MT, Day RO. Out-of-pocket spending among a cohort of Australians living with gout. Int J Rheum Dis 2020; 24:327-334. [PMID: 32975889 DOI: 10.1111/1756-185x.13979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To measure the direct and indirect out-of-pocket (OOP) costs borne by Australians with gout. METHODS A cross-sectional, Australia-wide, web-based survey was conducted over 12 months between May 2017 and April 2018. Participants were recruited via advertisements in doctors' clinics and healthcare organizations' websites, and social media platforms such as Facebook and Twitter. Survey questions collected information about participants' OOP spending on direct medical and non-medical gout-related healthcare costs. Participant demographics, gout status, healthcare sought, workdays lost to due gout and health-related quality of life were also collected. RESULTS Seventy-nine patients with gout completed the survey; 70 (89%) were male, and on average were 56 (SD 16) years of age and had gout for 14 (SD 12) years. For this cohort, the median total OOP direct medical cost was AU$200 per year (interquartile range [IQR]: AU$60-AU$570). Sixty (76%) people with gout reported being affected by gout during work; however, only 0.25 (IQR: 0-3) days of work (approximately $60) were lost due to gout in a year. Nine percent (n = 7) of participants experienced cost-related treatment attrition and 33% reported economic hardship (n = 26). Participants who experienced economic hardship or cost-related treatment attrition had higher median total gout-related direct costs than those who did not. CONCLUSION In Australia, gout has an OOP financial cost and reduces work productivity. The presence of cost-related treatment attrition among people with gout indicates that financial costs may be a significant barrier to seeking treatment for a subset of patients with gout.
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Affiliation(s)
- Nicholas Nathan
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Amy D Nguyen
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sophie Stocker
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Melissa T Baysari
- Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Richard O Day
- St Vincent's Clinical School, UNSW Sydney, Sydney, NSW, Australia.,Department of Clinical Pharmacology & Toxicology, St Vincent's Hospital, Sydney, NSW, Australia.,Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
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28
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Leung CW, Kullgren JT, Malani PN, Singer DC, Kirch M, Solway E, Wolfson JA. Food insecurity is associated with multiple chronic conditions and physical health status among older US adults. Prev Med Rep 2020; 20:101211. [PMID: 32983850 PMCID: PMC7502278 DOI: 10.1016/j.pmedr.2020.101211] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 01/22/2023] Open
Abstract
In the past two decades, food insecurity has increased by 45% among older adults but its relationship to health outcomes has not been extensively studied. The objective of this study was to examine the associations between food insecurity, multiple chronic conditions, and self-reported health status among a nationally representative sample of older U.S. adults. Data came from the National Poll on Healthy Aging, a national cross-sectional survey conducted in December 2019 among 2,048 individuals aged 50–80 years. Food insecurity was assessed using the six-item short form of the USDA Food Security Survey Module. The primary outcomes of interest were the number of self-reported chronic conditions and self-reported physical health status. Multinomial logistic regression models were used to examine the associations between food security status and the outcomes of interest, adjusting for sociodemographic characteristics. The overall prevalence of food insecurity among older adults was 14%. After adjustment for sociodemographic characteristics, food insecurity was positively associated with multiple chronic conditions (RRR 1.60, 95% CI 1.08, 2.36, for 2–3 conditions vs. 0–1; RRR 2.59, 95% CI 1.55, 4.33 for 4–10 chronic conditions vs. 0–1). Food insecurity was also associated with lower self-reported health status (RRR 1.84, 95% CI 1.16, 2.93 for good vs. excellent/ very good health; RRR 5.13, 95% CI 3.08, 8.52 for fair/poor vs. excellent/very good health). Food insecurity is an important social determinant of health among older adults. These findings can contribute to clinical and public health efforts to simultaneously alleviate food insecurity and promote health behaviors among older adults.
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Affiliation(s)
- Cindy W. Leung
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, USA
- Corresponding author: 1415 Washington Heights, SPH I Ann Arbor, MI 48109, USA.
| | - Jeffrey T. Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - Preeti N. Malani
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - Dianne C. Singer
- Department of Pediatrics, University of Michigan, Ann Arbor, USA
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - Julia A. Wolfson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, USA
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29
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Close S, Marshall-Gradisnik S, Byrnes J, Smith P, Nghiem S, Staines D. The Economic Impacts of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome in an Australian Cohort. Front Public Health 2020; 8:420. [PMID: 32974259 PMCID: PMC7472917 DOI: 10.3389/fpubh.2020.00420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to estimate direct and indirect health economic costs associated with government and out-of-pocket (OOP) expenditure based on health care service utilization and lost income of participants and carers, as reported by Australian Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patient survey participants. Design: A cost of illness study was conducted to estimate Australian cost data for individuals with a ME/CFS diagnosis as determined by the Canadian Consensus Criteria (CCC), International Consensus Criteria (ICC), and the 1994 CDC Criteria (Fukuda). Setting and participants: Survey participants identified from a research registry database provided self-report of expenditure associated with ME/CFS related healthcare across a 1-month timeframe between 2017 and 2019. Main outcome measures: ME/CFS related direct annual government health care costs, OOP health expenditure costs, indirect costs associated with lost income and health care service use patterns. Results: The mean annual cost of health care related expenditure and associated income loss among survey participants meeting diagnostic criteria for ME/CFS was estimated at $14.5 billion. For direct OOP and Government health care expenditure, high average costs were related to medical practitioner attendance, diagnostics, natural medicines, and device expenditure, with an average attendance of 10.6 referred attendances per annum and 12.1 GP visits per annum related specifically to managing ME/CFS. Conclusions: The economic impacts of ME/CFS in Australia are significant. Improved understanding of the illness pathology, diagnosis, and management, may reduce costs, improve patient prognosis and decrease the burden of ME/CFS in Australia.
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Affiliation(s)
- Shara Close
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Sonya Marshall-Gradisnik
- National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Peter Smith
- National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
| | - Son Nghiem
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
| | - Don Staines
- National Centre for Neuroimmunology and Emerging Diseases, Griffith University, Gold Coast, QLD, Australia
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30
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Abudukelimu A, Barberis M, Redegeld F, Sahin N, Sharma RP, Westerhoff HV. Complex Stability and an Irrevertible Transition Reverted by Peptide and Fibroblasts in a Dynamic Model of Innate Immunity. Front Immunol 2020; 10:3091. [PMID: 32117197 PMCID: PMC7033641 DOI: 10.3389/fimmu.2019.03091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/17/2019] [Indexed: 12/12/2022] Open
Abstract
We here apply a control analysis and various types of stability analysis to an in silico model of innate immunity that addresses the management of inflammation by a therapeutic peptide. Motivation is the observation, both in silico and in experiments, that this therapy is not robust. Our modeling results demonstrate how (1) the biological phenomena of acute and chronic modes of inflammation may reflect an inherently complex bistability with an irrevertible flip between the two modes, (2) the chronic mode of the model has stable, sometimes unique, steady states, while its acute-mode steady states are stable but not unique, (3) as witnessed by TNF levels, acute inflammation is controlled by multiple processes, whereas its chronic-mode inflammation is only controlled by TNF synthesis and washout, (4) only when the antigen load is close to the acute mode's flipping point, many processes impact very strongly on cells and cytokines, (5) there is no antigen exposure level below which reduction of the antigen load alone initiates a flip back to the acute mode, and (6) adding healthy fibroblasts makes the transition from acute to chronic inflammation revertible, although (7) there is a window of antigen load where such a therapy cannot be effective. This suggests that triple therapies may be essential to overcome chronic inflammation. These may comprise (1) anti-immunoglobulin light chain peptides, (2) a temporarily reduced antigen load, and (3a) fibroblast repopulation or (3b) stem cell strategies.
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Affiliation(s)
- Abulikemu Abudukelimu
- Synthetic Systems Biology and Nuclear Organization, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands.,Molecular Cell Physiology, VU University Amsterdam, Amsterdam, Netherlands
| | - Matteo Barberis
- Synthetic Systems Biology and Nuclear Organization, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands.,Systems Biology, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom.,Centre for Mathematical and Computational Biology, CMCB, University of Surrey, Guildford, United Kingdom
| | - Frank Redegeld
- Division of Pharmacology, Department of Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, Netherlands
| | - Nilgun Sahin
- Molecular Cell Physiology, VU University Amsterdam, Amsterdam, Netherlands
| | - Raju P Sharma
- Molecular Cell Physiology, VU University Amsterdam, Amsterdam, Netherlands
| | - Hans V Westerhoff
- Synthetic Systems Biology and Nuclear Organization, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, Netherlands.,Molecular Cell Physiology, VU University Amsterdam, Amsterdam, Netherlands.,School for Chemical Engineering and Analytical Science, University of Manchester, Manchester, United Kingdom.,Systems Biology Amsterdam, VU University Amsterdam, Amsterdam, Netherlands
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31
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Marck CH, Aitken Z, Simpson S, Weiland TJ, Kavanagh A, Jelinek GA. Predictors of Change in Employment Status and Associations with Quality of Life: A Prospective International Study of People with Multiple Sclerosis. JOURNAL OF OCCUPATIONAL REHABILITATION 2020; 30:105-114. [PMID: 31392475 PMCID: PMC7031412 DOI: 10.1007/s10926-019-09850-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Purpose This prospective international study aimed to assess the changes in employment, and predictors thereof, and associated change in mental health quality of life in people with multiple sclerosis (MS). Methods People with MS were recruited online through social media, forums and newsletters to complete an online English-language survey in 2012 and again in 2015, to assess changes in employment and clinical characteristics. Results 1276 people with MS of working age were included of whom 35.9% were employed full time, 25.6% part-time, 3.1% were unemployed and seeking employment, 19.7% were retired due to disability and 15.7% were not in the labour force. Part/full time employment decreased from 61.4 to 57.1% of the sample 2.5 years later, and 25.5% experienced some change in employment status. Lower level of education and higher level of disability at baseline predicted loss of employment at follow-up. 62.0% of the sample indicated that MS impacted on employment over their lifetime, associated with a lower level of education and progressive MS at time of diagnosis. Retiring due to disability was predictive of a decreased mental health related QOL score. Conclusion Employment status was negatively impacted by MS for most participants. We showed for the first time that employment loss was prospectively associated with poorer mental health related quality of life. Employment support including vocational services, reasonable flexibility in the workplace, and legal protection against discrimination should be widely available to assist people with MS, especially for those with progressive onset MS, higher disability and lower levels of education who are at higher risk of employment loss.
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Affiliation(s)
- Claudia H Marck
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia.
| | - Zoe Aitken
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Tracey J Weiland
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Anne Kavanagh
- Disability and Health Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - George A Jelinek
- Neuroepidemiology Unit, The Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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32
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Berkovic D, Ayton D, Briggs AM, Ackerman IN. "The Financial Impact Is Depressing and Anxiety Inducing": A Qualitative Exploration of the Personal Financial Toll of Arthritis. Arthritis Care Res (Hoboken) 2020; 73:671-679. [PMID: 32100969 DOI: 10.1002/acr.24172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/18/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The financial experience faced by working-age people with arthritis includes living below the poverty line for many. Financial distress among people with arthritis is known to contribute to poorer health outcomes, including high psychological distress and more severe pain. Despite the demonstrated societal cost of arthritis care and management, the personal costs borne by the individual are not well understood. The aim of this study was to explore the perceived financial impacts of living with arthritis among younger adults (defined as those ages 18-50 years). METHODS A qualitative descriptive study design was used. Participants with inflammatory arthritis or osteoarthritis were recruited from the community, including urban and rural settings. An interview schedule was developed, informed by existing literature, which was piloted prior to data collection. Deductive and inductive coding techniques were used to identify financial-related themes arising from the data. RESULTS Semistructured interviews were conducted with 21 adults (90% female) with a mix of arthritis conditions, including rheumatoid arthritis, psoriatic arthritis, and osteoarthritis. Four themes were identified: direct arthritis-attributable medical costs, indirect arthritis-attributable costs, insurance and pension costs, and broader financial impacts on the family. Nonsubsidized costs were frequently referenced by participants as burdensome and existed even within the publicly funded Australian health care system. CONCLUSION Adults with arthritis experience significant arthritis-attributable financial burden and related distress. Financial concerns should be actively identified and considered within shared clinical decision-making to provide more patient-centered care for these individuals.
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Qiu R, Schick-Makaroff K, Tang L, Wang X, Zhang Q, Ye Z. Chinese Hospitalized Cardiovascular Patients' Attitudes Towards Self-Management: A Qualitative Study. Patient Prefer Adherence 2020; 14:287-300. [PMID: 32109995 PMCID: PMC7034970 DOI: 10.2147/ppa.s236348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/01/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study is aiming to investigate cardiovascular patients' attitudes towards self-management during hospitalization in China. PATIENTS AND METHODS Twenty-nine individuals living with cardiovascular disease from one designated Cardiology Department in Hangzhou, China, were recruited through a purposive sampling procedure. A qualitative descriptive methodology was used. Semi-structured interviews were also used to gain attitudes toward self-management. The interviews were audio-recorded, transcribed and analyzed by thematic analysis to develop the results. RESULTS Four themes were identified from the qualitative data: (1): Responsibilities of self-management; (2): Reflections on self-management; (3): Acknowledgement of self-management support; (4): Challenges in implementing and adherence to self-management. Additionally, interview data were also given to illustrate these main themes emerging during the analysis. Patients gradually took their responsibilities to manage chronic symptoms. During their self-management process, they did reflections to help correct their regiments through supportive interactions. Health system responsiveness, health disparities, social capital, and cultural setting were the main external factors influencing better self-management implementation and adherence. CONCLUSION This study revealed the hospitalized cardiovascular patients' attitudes towards self-management in China. These findings emphasized the importance of patients' responsibility, reflections, and various social support receiving and pointed out specific external factors influencing the health outcomes and their quality of life. This study also proves the guide for the policymakers and health system better instructions to develop individually and culturally tailored advanced self-management interventions and programs.
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Affiliation(s)
- Ruolin Qiu
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | | | - Leiwen Tang
- Zhejiang University School of Medicine, Affiliated Sir Run Run Shaw Hospital, Hangzhou, Zhejiang, People’s Republic of China
| | - Xiyi Wang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Qi Zhang
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhihong Ye
- Faculty of Nursing, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Correspondence: Zhihong Ye Faculty of Nursing, Zhejiang University School of Medicine, #704, Administrative Building, 3 East Qingchun Road, Hangzhou, Zhejiang310016, People’s Republic of ChinaTel +86 136 0661 2119 Email
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Halpin D. Chronic Obstructive Pulmonary Disease and Work: Is It Time to Stop? Am J Respir Crit Care Med 2019; 200:1195-1197. [PMID: 31513746 PMCID: PMC6857494 DOI: 10.1164/rccm.201908-1627ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- David Halpin
- University of Exeter Medical SchoolUniversity of Exeter College of Medicine and HealthExeter, United Kingdomand.,Royal Devon and Exeter HospitalExeter, United Kingdom
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35
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DiGiacomo M, Chang S, Luckett T, Agar M, Phillips J, Lam L. Financial stress experienced by informal carers of adults with a chronic disease: Results from an Australian population-based cross-sectional survey. Australas J Ageing 2019; 39:254-262. [PMID: 31680413 DOI: 10.1111/ajag.12739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. METHODS Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. RESULTS Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48-3.86), transport assistance (AOR = 1.89, 95% CI = 1.15-3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14-3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24-3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30-0.81) or dementia (AOR = 0.40, 95% CI = 0.21-0.76) was associated with decrease in odds. CONCLUSIONS Financial stress was reported by more than 13% of carers, and factors other than household income were implicated.
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Affiliation(s)
- Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Sungwon Chang
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Meera Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,South Western Sydney Clinical School, Liverpool Hospital, University of New South Wales (UNSW), Liverpool, NSW, Australia.,Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia
| | - Lawrence Lam
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia.,Tung Wah College, Hong Kong SAR, China
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Olsson M, Bajpai R, Wee L, Yew Y, Koh M, Thng S, Car J, Järbrink K. The cost of childhood atopic dermatitis in a multi‐ethnic Asian population: a cost‐of‐illness study. Br J Dermatol 2019; 182:1245-1252. [DOI: 10.1111/bjd.18442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 11/27/2022]
Affiliation(s)
- M. Olsson
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Queensland University of Technology Kelvin Grove Queensland Australia
| | - R. Bajpai
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Research Institute for Primary Care and Health Sciences Keele University Staffordshire ST55BG U.K
| | - L.W.Y. Wee
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - Y.W. Yew
- National Skin Centre 1 Mandalay Road Singapore 308205
| | - M.J.A. Koh
- Dermatology Service KK Women's and Children's Hospital Singapore
| | - S. Thng
- National Skin Centre 1 Mandalay Road Singapore 308205
- Skin Research Institute of Singapore Singapore
| | - J. Car
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
- Global eHealth Unit Department of Primary Care and Public Health School of Public Health Imperial College London 3rd floor Reynolds Building, St Dunstan's Road London W6 8RP U.K
| | - K. Järbrink
- Centre for Population Health Sciences (CePHaS) Lee Kong Chian School of Medicine Nanyang Technological University Clinical Sciences Building, 11 Mandalay Road Singapore 308232 Singapore
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Sukkar L, Talbot B, Jun M, Dempsey E, Walker R, Hooi L, Cass A, Jardine M, Gallagher M. Protocol for the Study of Heart and Renal Protection-Extended Review: Additional 5-Year Follow-up of the Australian, New Zealand, and Malaysian SHARP Cohort. Can J Kidney Health Dis 2019; 6:2054358119879896. [PMID: 31662874 PMCID: PMC6794650 DOI: 10.1177/2054358119879896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 08/11/2019] [Indexed: 11/17/2022] Open
Abstract
Background: There are limited studies on the effects of statins on outcomes in the
moderate chronic kidney disease (CKD) population and their trajectory to
end-stage kidney disease. Objective: To examine the long-term effects of lipid-lowering therapy on all-cause
mortality, cardiovascular morbidity, CKD progression, and socioeconomic
well-being in Australian, New Zealand, and Malaysian SHARP (Study of Heart
and Renal Protection) trial participants—a randomized controlled trial of a
combination of simvastatin and ezetimibe, compared with placebo, for the
reduction of cardiovascular events in moderate to severe CKD. Design: Protocol for an extended prospective observational follow-up. Setting: Australian, New Zealand, and Malaysian participating centers in patients with
advanced CKD. Patients: All SHARP trial participants alive at the final study visit. Measurements: Primary outcomes were measured by participant self-report and verified by
hospital administrative data. In addition, secondary outcomes were measured
using a validated study questionnaire of health-related quality of life, a
56-item economic survey. Methods: Participants were followed up with alternating face-to-face visits and
telephone calls on a 6-monthly basis until 5 years following their final
SHARP Study visit. In addition, there were 6-monthly follow-up telephone
calls in between these visits. Data linkage to health registries in
Australia, New Zealand, and Malaysia was also performed. Results: The SHARP-Extended Review (SHARP-ER) cohort comprised 1136 SHARP participants
with a median of 4.6 years of follow-up. Compared with all SHARP
participants who originally participated in the Australian, New Zealand, and
Malaysian regions, the SHARP-ER participants were younger (57.2 [48.3-66.4]
vs 60.5 [50.3-70.7] years) with a lower proportion of men (61.5% vs 62.8%).
There were a lower proportion of participants with hypertension (83.7% vs
85.0%) and diabetes (20.0% vs 23.5%). Limitations: As a long-term follow-up study, the surviving cohort of SHARP-ER is a
selected group of the original study participants, which may limit the
generalizability of the findings. Conclusion: The SHARP-ER study will contribute important evidence on the long-term
outcomes of cholesterol-lowering therapy in patients with advanced CKD with
a total of 10 years of follow-up. Novel analyses of the socioeconomic impact
of CKD over time will guide resource allocation. Trial Registration: The SHARP trial was registered at ClinicalTrials.gov NCT00125593 and ISRCTN
54137607.
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Affiliation(s)
- Louisa Sukkar
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Ben Talbot
- The George Institute for Global Health, Newtown, Australia
| | - Min Jun
- The George Institute for Global Health, Newtown, Australia
| | - Erika Dempsey
- The George Institute for Global Health, Newtown, Australia
| | - Robert Walker
- Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lai Hooi
- Hospital Sultanah Aminah, Johor Bahru, Malaysia
| | - Alan Cass
- Menzies School of Health Research, Casuarina, NT, Australia
| | - Meg Jardine
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Martin Gallagher
- The George Institute for Global Health, Newtown, Australia.,Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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How Surrogate Decision-Makers for Patients With Chronic Critical Illness Perceive and Carry Out Their Role. Crit Care Med 2019; 46:699-704. [PMID: 29462004 DOI: 10.1097/ccm.0000000000003035] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Family members commonly make medical decision for patients with chronic critical illness. This study examines how family members approach this decision-making role in real time. DESIGN Qualitative analysis of interviews with family members in the intervention arm of a randomized controlled communication trial. SETTINGS Medical ICUs at four U.S. hospitals. PARTICIPANTS Family members of patients with chronic critical illness (adults mechanically ventilated for ≥ 7 d and expected to remain ventilated and survive for ≥ 72 hr) who participated in the active arm of a communication intervention study. INTERVENTIONS Family members participated in at least two content-guided, informational, and emotional support meetings led by a palliative care physician and nurse practitioner. MEASUREMENTS AND MAIN RESULTS Grounded theory was used for qualitative analysis of 66 audio recordings of meetings with 51 family members. Family members perceived their role in four main ways: voice of the patient, advocate for the patient, advocate for others, and advocate for oneself. Their decision-making was characterized by balancing goals, sharing their role, keeping perspective, remembering previous experiences, finding sources of strength, and coping with various burdens. CONCLUSIONS Family members take a multifaceted approach as they participate in decision-making. Understanding how surrogates perceive and act in their roles may facilitate shared decision-making among clinicians and families during critical care.
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Graham EA, Thomson KH, Bambra CL. The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe. Eur J Public Health 2019; 28:872-878. [PMID: 29617999 PMCID: PMC6148969 DOI: 10.1093/eurpub/cky050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Depressive symptoms are more common in adults with diabetes and may arise from the physical and psychosocial burden of disease. Better quality of diabetes care may be associated with a reduced disease burden and fewer depressive symptoms. Methods This cross-sectional study included 34 420 participants from 19 countries in the European Social Survey Round 7 (2014-2015). Countries were grouped into quartiles based on their quality of diabetes care as measured in the Euro Diabetes Index 2014. Individual-level depressive symptoms were measured using the 8-item Center for Epidemiologic Studies-Depression Scale. Negative binomial regression was used to compare the number of depressive symptoms between adults with and without diabetes in each quartile of diabetes care quality. Analyses included adjustment for covariates and survey weights. Results In countries with the highest quality of diabetes care, having diabetes was associated with only a 3% relative increase in depressive symptoms (95% CI 1.00-1.05). In countries in the second, third and fourth (lowest) quartiles of diabetes care quality, having diabetes was associated with a 13% (95% CI 1.08-1.17), 13% (1.08-1.19) and 22% (1.14-1.31) relative increase in depressive symptoms, respectively. Conclusion The association between diabetes and depressive symptoms appears stronger in European countries with lower quality of diabetes care. Potential pathways for this association include the financial aspects of diabetes care, access to services and differential exposure to the social determinants of heath. Further research is needed to unpack these mechanisms and improve the quality of life of people with diabetes across Europe.
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Affiliation(s)
- Eva A Graham
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare L Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Sebai J. [Citizen participation in efforts to improve the quality and safety of care]. SANTE PUBLIQUE 2019; 30:623-631. [PMID: 30767479 DOI: 10.3917/spub.186.0623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Given the changing needs of the user, the model of public service administration that was once constructed in ignorance of the user and his concerns no longer finds its place. There is therefore mention of a reversal of trends and a modernization of public institutions and structures based on a reflective approach that over-emphasizes the user's place in the system as beneficiary, recipient and partner of the care service. The participation and the viewpoint of the user constitute therefore a very important stake in the improvement of the quality of the care and the evaluation of the health technologies. Convinced of the importance of involving users in efforts to improve the quality and safety of healthcare, the High Authority for Health (HAS), as a public institution for health democracy in France, has put in place cooperation projects between health professionals and beneficiaries translated into working groups and committees. Through this approach, the HAS gives the beneficiaries the role of experts enabling them, through their experiential expertise to express themselves in the process of modernization and improvement of certification and quality and safety of care. It is with the aim of understanding the various modalities and the level of involvement of users' representatives in the quality procedures in general and in the certification of healthcare institutions in particular that we will try in this contribution to highlight the obstacles and the means in the health sector in France.
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Walker RC, Tong A, Howard K, Palmer SC. Patient expectations and experiences of remote monitoring for chronic diseases: Systematic review and thematic synthesis of qualitative studies. Int J Med Inform 2019; 124:78-85. [PMID: 30784430 DOI: 10.1016/j.ijmedinf.2019.01.013] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/13/2019] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To describe the range of patients' beliefs, attitudes, expectations, and experiences of remote monitoring for chronic conditions across different healthcare contexts and populations. DESIGN We searched MEDLINE, Embase, PsychINFO, and CINAHL, Google Scholar, and reference lists of related studies through to July 2017. Thematic synthesis was used to analyse the findings of the primary studies. Study characteristics were examined to explain differences in findings. SETTING All healthcare settings PARTICIPANTS: Adults with chronic diseases OUTCOMES: Patient beliefs, attitudes, expectations and experiences of remote monitoring RESULTS: We included 16 studies involving 307 participants with chronic obstructive pulmonary disease, heart failure, diabetes, hypertension, and end stage kidney disease. The studies were conducted in 8 countries. We identified four themes: gaining knowledge and triggering actions (tracking and responding to change, prompting timely and accessible care, supporting self-management and shared decision-making); reassurance and security (safety in being alone, peace of mind); concern about additional burden (reluctance to learn something new, lack of trust in technology, avoiding additional out-of-pocket costs), and jeopardising interpersonal connections (fear of being lost in data, losing face to face contact). CONCLUSIONS For patients with chronic disease, remote monitoring increased their disease-specific knowledge, triggered earlier clinical assessment and treatment, improved self-management and shared decision-making. However, these potential benefits were balanced against concerns about losing interpersonal contact, and the additional personal responsibility of remote monitoring.
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Affiliation(s)
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, 8140, New Zealand; Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
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Kang SH, Ju YJ, Yoon HJ, Lee SA, Kim W, Park EC. The relationship between catastrophic health expenditure and health-related quality of life. Int J Equity Health 2018; 17:166. [PMID: 30428892 PMCID: PMC6237009 DOI: 10.1186/s12939-018-0883-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/30/2018] [Indexed: 01/21/2023] Open
Abstract
Objectives The objective of our study was to investigate the relationship between catastrophic health expenditure (CHE) and health-related quality of life (HRQoL) in general population. Methods We used Korean Health Panel Survey data from 2011 to 2013, which included data from 8850 baseline participants of 19 years of age or older. We defined CHE as total annual out-of-pocket health payment that was 40% greater than the household’s capacity to pay. HRQoL was measured using the EuroQol-visual analogue scale (EQ-VAS). We used generalized estimating equations to perform a longitudinal regression analysis. Results A total of 4.5% of the participants (n = 398) experienced CHE. Those with CHE tended to have a lower EQ-VAS index score compared with those without CHE (β: − 1.34, p = 0.013). A subgroup analysis revealed that individuals experiencing CHE had significant decreases as the number of chronic diseases increased (three or more, β: − 1.85, p = 0.014). Conclusions Catastrophic health expenditure influences HRQoL, which was more pronounced in patient with chronic disease. The efforts should focus on people who suffer from excessive health expenditures and chronic diseases.
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Affiliation(s)
- Seung Hyun Kang
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Yeong Jun Ju
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyo Jung Yoon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sang Ah Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Preventive Medicine and Institute of Health Services Research, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Korea.
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Amanatullah DF, Murasko MJ, Chona DV, Crijns TJ, Ring D, Kamal RN. Financial Distress and Discussing the Cost of Total Joint Arthroplasty. J Arthroplasty 2018; 33:3394-3397. [PMID: 30057266 DOI: 10.1016/j.arth.2018.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total joint arthroplasty is expensive. Out-of-pocket cost to patients undergoing elective total joint arthroplasty varies considerably depending on their insurance coverage but can range into the tens of thousands of dollars. The goal of this study is to evaluate the association between patient financial stress and interest in discussing costs associated with surgery. METHODS One hundred forty-one patients undergoing elective total hip and knee arthroplasty at a suburban academic medical center were enrolled and completed questionnaires about cost prior to surgery. Questions regarding if and when doctors should discuss the cost of healthcare with patients, evaluating if patients were affected by the cost of healthcare and to what extent, and financial security scores to assess current financial situation were included. The primary outcome was the answer to the question of whether a doctor should discuss cost with patients. RESULTS Financial stress was found to be associated with patient experience of hardship due to cost of care [P = .004], likelihood to turn down a test or treatment due to copayment [P = .029], to decline a test or treatment due to other costs [P = .003], to experience difficulty affording basic necessities [P = .008], and to have used up all or most of their savings to pay for surgery [P = .011]. In total, 84% of patients reported that they wanted to discuss surgical costs with their doctors, but 90% did not want to do so at every visit. CONCLUSION Total joint arthroplasty creates considerable out-of-pocket costs that may affect patient decisions. These findings help elucidate important patient concerns that orthopedic surgeons should account for when discussing elective arthroplasty with patients.
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Affiliation(s)
- Derek F Amanatullah
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Marlon J Murasko
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Tom J Crijns
- Department of Surgery and Perioperative Care, University of Texas, Austin - Dell Medical School, Austin, Texas
| | - David Ring
- Department of Surgery and Perioperative Care, University of Texas, Austin - Dell Medical School, Austin, Texas
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
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Pacheco Barzallo D. Place of residence & financial hardship: the situation of people with spinal cord injury. Int J Equity Health 2018; 17:115. [PMID: 30089482 PMCID: PMC6083562 DOI: 10.1186/s12939-018-0818-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 07/10/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even with universal health coverage, people with long-term medical conditions can face financial hardship. However, financial hardship can be not only the result of an increase in health care costs; it has other socio-economic determinants that can cause social inequalities in terms of health. This study aims to estimate the impact of the place of residence on the financial hardship of people with spinal cord injury (SCI) in Switzerland. Switzerland is an interesting case to analyze because of its political system, where each of the 26 cantons is autonomous and responsible for raising its own income (through taxes) and providing public services. METHODS Using cross-sectional data from the Swiss Spinal Cord Injury Cohort Study (SwiSCI), this paper estimates the probability of financial hardship by place of residence. The data set, recorded between 2011 and 2013, comprises information from 1549 participants aged 16 years and older, living with SCI. RESULTS The results show that people face different probabilities of financial hardship, depending on their place of residence. In general, people in the French-speaking cantons have a higher probability of financial hardship compared with people living in the German- or Italian-speaking cantons. People in the cantons of Geneva and Graubünden have almost five times the probability of financial hardship, compared with people in the canton with the lowest probability of financial hardship, Zug. CONCLUSIONS The place of residence is a determinant of the financial situation of a household where a member deals with a long-term health condition. The differences might arise due to variations in health care costs, the tax burden and social support system, which are regulated and administered by each canton.
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Affiliation(s)
- Diana Pacheco Barzallo
- Swiss Paraplegic Research, Health Services Statistics & Economics Group, Guido A. Zach Strasse 4., 6207, Nottwil, Switzerland.
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46
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Playford ED. Work status in MS: A proxy measure for comprehensive MS management. Mult Scler 2018; 22:1766-1767. [PMID: 27941155 DOI: 10.1177/1352458516681506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- E D Playford
- Warwick Medical School, University of Warwick, Coventry, UK
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Guo VYW, Wong CKH, Wong RSM, Yu EYT, Ip P, Lam CLK. Spillover Effects of Maternal Chronic Disease on Children’s Quality of Life and Behaviors Among Low-Income Families. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 11:625-635. [DOI: 10.1007/s40271-018-0314-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, Silkensen S, Brand N, Looi LM, Pai SA, Wilson ML, Milner D, Flanigan J, Fleming KA. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. Lancet 2018; 391:1939-1952. [PMID: 29550027 DOI: 10.1016/s0140-6736(18)30459-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
Abstract
Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya.
| | - William Cherniak
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Lawler
- Faculty of Medicine, Health, and Life Sciences and Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK
| | - Soo Yong Tan
- Department of Pathology, National University of Singapore, National University Hospital, Singapore
| | - Wafaa El Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Nicholas Wolf
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shannon Silkensen
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathan Brand
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lai Meng Looi
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay A Pai
- Columbia Asia Referral Hospital, Bangalore, Karnataka, India
| | - Michael L Wilson
- Department of Pathology and Laboratory Services, Denver Health, Denver, CO, USA; Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danny Milner
- American Society for Clinical Pathology, Chicago, IL, USA
| | - John Flanigan
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth A Fleming
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Green Templeton College, University of Oxford, Oxford, UK
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Abstract
OBJECTIVE Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity. DESIGN Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS. SETTING USA. SUBJECTS Respondents of the 2013 HRS HCNS with household incomes <300 % of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, ≥5 conditions), with multiple chronic conditions (MCC) defined as ≥2 conditions. RESULTS The prevalence of food insecurity was 27·8 %. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2·12 (95 % CI 1·45, 3·09) and for those with ≥5 conditions being 3·64 (95 % CI 2·47, 5·37). CONCLUSIONS A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.
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Okediji PT, Ojo AO, Ojo AI, Ojo AS, Ojo OE, Abioye-Kuteyi EA. The Economic Impacts of Chronic Illness on Households of Patients in Ile-Ife, South-Western Nigeria. Cureus 2017; 9:e1756. [PMID: 29226046 PMCID: PMC5720589 DOI: 10.7759/cureus.1756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Chronic illnesses are slowly becoming more prevalent worldwide. The implications and ramifications of these illnesses vary and affect not only the patient but the entire household in many ways. This research focuses on the economic implications of this category of illnesses on the entire household. The aim is to determine the economic implications of chronic illnesses on households of patients in selected health facilities in Ile-Ife, Nigeria, and to elucidate the various coping strategies applied by households in low and middle income countries (LMICs) to keep up with these economic implications. Methods This study features a descriptive cross-sectional survey design with a total sample of 443. The target population consists of individuals with chronic diseases in selected health care facilities in Ile-Ife. Results The mean household monthly incomes before and after illness episodes were found to be $335.84 and $318.01, respectively. The mean direct cost of chronic illness was $137.72 with about 79% (n=350) of the respondents spending more than 10% of the monthly household income on health. The indirect costs of illness were a loss of productivity of 18.9% and 5.1% for patients and caregivers, respectively. A large percentage of the respondents resorted to borrowing (44.7%; n=198), while another 5.0% (n=22) sold assets, and 8.6% (n=38) had access to health insurance in order to cope with the economic impacts of the illness. Conclusion The study showed that chronic illnesses imposed high and catastrophic cost burdens on patients and their households. The lack of effective coping strategies points at the need for policymakers to improve access to specialized care and increase coverage of formal health insurance so as to ameliorate the significant economic impacts that chronic illnesses have on entire households.
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Affiliation(s)
| | - Adedolapo O Ojo
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Akinwumi I Ojo
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Ademola S Ojo
- Department of Surgery, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Opeyemi E Ojo
- Department of Medicine, Ekiti State University Teaching Hospital, Ekiti State. Nigeria
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