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Sum G, Ishida M, Koh GCH, Singh A, Oldenburg B, Lee JT. Implications of multimorbidity on healthcare utilisation and work productivity by socioeconomic groups: Cross-sectional analyses of Australia and Japan. PLoS One 2020; 15:e0232281. [PMID: 32343739 PMCID: PMC7188213 DOI: 10.1371/journal.pone.0232281] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multimorbidity, the presence of 2 or more non-communicable diseases (NCDs), is a major contributor to inequalities of health in Australia and Japan. We use nationally representative data to examine (i) the relationships between multimorbidity with healthcare utilisation and productivity loss and (ii) whether these relationships differed by socioeconomic groups. METHODS Cross-sectional analyses using the Household, Income, and Labour Dynamics in Australia (HILDA) and the Japanese Study of Aging and Retirement (JSTAR) surveys. We examined 6,382 (HILDA) and 3,503 (JSTAR) adults aged ≥50 years. We applied multivariable regression, logistic and negative binomial models. RESULTS Prevalence of multimorbidity was overall 38.6% (46.0%, 36.1%, 28.9% amongst those in the lowest, middle and highest education group, respectively) in Australia, and 28.4% (33.9%, 24.6%, 16.6% amongst those in the lowest, middle and highest education group, respectively) in Japan. In Australia and Japan, more NCDs was associated with greater healthcare utilisation. In Australia and Japan, more NCDs was associated with higher mean number of sick leave days amongst the employed and lower odds of being employed despite being in the labour force. The association between multimorbidity and lower retirement age was found in Australia only. CONCLUSION Having more NCDs pose significant economic burden to the health system and wider society in Australia and Japan. Targeted policies are critical to improve financial protection, especially for lower income groups who are more likely to have multiple NCDs. These individuals incur both high direct and indirect costs, which lead to a greater risk of impoverishment.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- * E-mail:
| | - Marie Ishida
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ankur Singh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - John Tayu Lee
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England, United Kingdom
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Siemon J, Galli J, Slomovitz B, Schlumbrecht M. Disparities in care among patients with low-grade serous ovarian carcinoma. Gynecol Oncol 2020; 157:46-54. [PMID: 32008792 DOI: 10.1016/j.ygyno.2019.12.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/23/2019] [Accepted: 12/25/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Low-grade serous carcinoma (LGSC) is a rare histotype of ovarian cancer with a unique disease course. Little data exist regarding the influence of sociodemographic factors on diagnosis and outcomes in this disease. Our objective was to evaluate the associations between these factors and the clinical characteristics, treatment approaches, and survival in LGSC. METHODS The National Cancer Database (NCDB) was queried for data between 2004 and 2015 on patients with LGSC. LGSC was inclusive of invasive, grade 1, serous carcinoma of the ovary, fallopian tube, or peritoneum. Patient demographics, insurance status, disease characteristics, treatment approach, and survival were evaluated. ANOVA, Chi Square, Kaplan-Meier, and Cox regression were used in the analysis. RESULTS 3221 patients with LGSC were evaluated (89.5% White, 6.2% Black; 7.2% Hispanic, 92.8% non-Hispanic). Compared to Whites, Blacks were diagnosed younger (50.4 vs. 55.9 years, p < 0.01), received less chemotherapy (61.8% vs 67.0%, p = 0.04), and had less CA-125 elevation (OR 4.14 [1.26-13.57], p = 0.02). Compared to non-Hispanics, Hispanics were younger (49.5 vs. 55.8 years, p < 0.01) and received less chemotherapy (55% vs 67%, p < 0.001). In contrast to private insurance, government insurance was associated with a higher 30-day mortality (1.5% vs 0.01%, p < 0.001). Race/ethnicity were not predictive of OS, while older age (HR 1.013 [1.002-1.024], p = 0.03), advanced stage (HR 3.09 [2.15-4.43], p < 0.001), and government insurance (HR 2.33 [1.65-3.30], p < 0.001) were all independently associated with worse OS. CONCLUSIONS Significant differences exist in the clinical characteristics, treatments, and outcomes of LGSC by sociodemographics, with Blacks and Hispanics being diagnosed younger and receiving less chemotherapy. Age, stage, and insurance status were predictive of overall survival.
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Affiliation(s)
- J Siemon
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States.
| | - J Galli
- University of Miami Ryan White Program, Miami, FL, United States
| | - B Slomovitz
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
| | - M Schlumbrecht
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States
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Giannitrapani KF, Ahluwalia SC, McCaa M, Pisciotta M, Dobscha S, Lorenz KA. Barriers to Using Nonpharmacologic Approaches and Reducing Opioid Use in Primary Care. PAIN MEDICINE 2020; 19:1357-1364. [PMID: 29059412 DOI: 10.1093/pm/pnx220] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Opioid prescribing for chronic pain, including the potential for over-reliance and misuse, is a public health concern. OBJECTIVE In the context of Veterans Administration (VA) primary care team-based pain management, we aimed to understand providers' perceptions of barriers to reducing opioid use and improving the use of nonpharmacologic pain management therapies (NPTs) for chronic pain. DESIGN A semistructured interview elucidated provider experiences with assessing and managing pain. Emergent themes were mapped to known dimensions of VA primary care access. SUBJECTS Informants included 60 primary care providers, registered nurses, licensed practical nurses, clerks, psychologists, and social workers at two VA Medical Centers. METHODS Nine multidisciplinary focus groups. RESULTS Provider perceptions of barriers to reducing opioids and improving use of NPTs for patients with chronic pain clustered around availability and access. Barriers to NPT access included the following subthemes: geographical (patient distance from service), financial (out-of-pocket cost to patient), temporal (treatment time delays), cultural (belief that NPTs increased provider workload, perception of insufficient training on NPTs, perceptions of patient resistance to change, confrontation avoidance, and insufficient leadership support), and digital (measure used for pain assessment, older patients hesitant to use technology, providers overwhelmed by information). CONCLUSIONS Decreasing reliance on opioids for chronic pain requires a commitment to local availability and provider-facing strategies that increase efficacy in prescribing NPTs. Policies and interventions for decreasing utilization of opioids and increasing use of NPTs should comprehensively consider access barriers.
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Affiliation(s)
- Karleen F Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Sangeeta C Ahluwalia
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.,The RAND Corporation, Santa Monica, California, USA
| | - Matthew McCaa
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Maura Pisciotta
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
| | - Steven Dobscha
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
| | - Karl A Lorenz
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA.,The RAND Corporation, Santa Monica, California, USA.,Stanford School of Medicine, Stanford, California, USA
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Guglielmetti Mugion R, Musella F, Di Pietro L, Toni M. The “service excellence chain”: an empirical investigation in the healthcare field. TQM JOURNAL 2020. [DOI: 10.1108/tqm-11-2018-0181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe linkage between internal and external satisfaction is an understudied topic in the service field. This study aims to address this gap by proposing an original research model, the service excellence chain (SEC), that connects the internal and external perspectives by conjoining performance-excellence models and the service-profit-chain approach. Theoretical assumptions and quantitative measures are proposed by using advanced statistical techniques.Design/methodology/approachThe SEC is investigated through an empirical study in the healthcare sector, focusing on an Italian hospital and involving two of its core units. Qualitative and quantitative approaches were used. First, internal and external customer satisfaction were separately tested through structural equation modeling. The linkage between internal and external satisfaction is then proposed by mathematically defining a synthetic index, the internal and external customer satisfaction index (IEGSI), modeled through Bayesian networks (BNs) and object-oriented BNs to provide an overall measure able to predict organizational improvement.FindingsThe distinct measured models show good internal validity and adequate fit both for patients' and employees' perspectives. The IEGSI allows rigorously connecting internal and external satisfaction by developing conjoint scenarios for organizational improvement.Originality/valueThis study proposes the SEC model as an innovative way to connect internal and external satisfaction. The findings can be useful both for private and public organizations and may provide several useful insights for healthcare managers as well as for policy-makers in relation to developing strategies for improving service quality.
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Geographic Variation in Outcomes After Burn Injury: A Burn Model System National Database Study. Ann Plast Surg 2020; 84:644-650. [PMID: 32040001 DOI: 10.1097/sap.0000000000002287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Geography is an important yet underexplored factor that may influence the care and outcomes of burn survivors. This study aims to examine the impact of geography on physical and psychosocial function after burn injury. METHODS Data from the Burn Model Systems National Database (1997-2015) were analyzed. Individuals 18 years and older who were alive at discharge were included. Physical and psychosocial functions were assessed at 6, 12, and 24 months postinjury using the following patient-reported outcome measures: Community Integration Questionnaire, Physical Composite Scale and Mental Composite Scale of the 12-Item Short Form Health Survey, Satisfaction with Appearance Scale, and Satisfaction with Life Scale. Descriptive statistics were generated for demographic and medical data, and mixed regression models were used to assess the impact of geography on long-term outcomes. RESULTS The study included 469 burn survivors from the Centers for Medicare and Medicaid Services regions 10, 31 from region 8, 477 from region 6, 267 from region 3, and 41 from region 1. Participants differed significantly by region in terms of race/ethnicity, burn size, burn etiology, and acute care length of stay (P < 0.001). In adjusted mixed model regression analyses, scores of all 5 evaluated outcome measures were found to differ significantly by region (P < 0.05). CONCLUSIONS Several long-term physical and psychosocial outcomes of burn survivors vary significantly by region. This variation is not completely explained by differences in population characteristics. Understanding these geographical differences may improve care for burn survivors and inform future policy and resource allocation.
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Amissah J, Nakua EK, Badu E, Amissah AB, Lariba L. In search of universal health coverage: the hidden cost of family planning to women in Ghana. BMC Res Notes 2020; 13:58. [PMID: 32029007 PMCID: PMC7006161 DOI: 10.1186/s13104-020-4928-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/29/2020] [Indexed: 12/17/2022] Open
Abstract
Objective This study aims to estimate the cost of accessing FP services in Ghana. A cross-sectional design, involving quantitative methods were used to recruit 1194 women who accessed FP services in 336 primary health facilities, selected through a two-stage sampling. Descriptive statistics were used to estimate the cost, using STATA 13. Results The average age of the women was 29 ± 6.87. Most women had basic education. The sources of payment for FP services were self-finance, family and sponsorship. The average direct cost of accessing FP services was GHS 7.90 [US$ 1.76]. The cost of FP services was highest for consultation GHS 7.50 [US$ 1.67], Laboratory test/x-ray GHS 6.03 [US$ 1.34], Transportation GHS GHS5.50 [US$ 1.22], Contraceptive GHS 4.73 [US$ 1.05] and Client records Card GHS 3.30 [US$ 0.73]. The cost of FP services was higher for clients visiting private facilities, tertiary level as well as those in urban centers. Clients on average spent 54.21 min traveling at a distance of 3.49 km and wait averagely 18.11 min for each visit. Government stakeholders are encouraged to revise the existing maternal health policies, as well as increase the list of FP services within the exemption package of the NHIS policy.
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Affiliation(s)
- John Amissah
- Department of Health Policy Planning, Management and Economics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Kwaku Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eric Badu
- Department of Nursing, University of Newcastle, Callaghan, Australia
| | - Alexander Baba Amissah
- Institute of Continuous Education and Distance Learning, University of Ghana, Legon, Accra, Ghana
| | - Leticia Lariba
- Department of Pharmaceutics, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Donnelly JP, Lakkur S, Judd SE, Levitan EB, Griffin R, Howard G, Safford MM, Wang HE. Association of Neighborhood Socioeconomic Status With Risk of Infection and Sepsis. Clin Infect Dis 2019; 66:1940-1947. [PMID: 29444225 PMCID: PMC6248765 DOI: 10.1093/cid/cix1109] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/12/2018] [Indexed: 02/03/2023] Open
Abstract
Background Prior studies suggest disparities in sepsis risk and outcomes based on place of residence. We sought to examine the association between neighborhood socioeconomic status (nSES) and hospitalization for infection and sepsis. Methods We conducted a prospective cohort study using data from 30239 participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. nSES was defined using a score derived from census data and classified into quartiles. Infection and sepsis hospitalizations were identified over the period 2003-2012. We fit Cox proportional hazards models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs) and examining mediation by participant characteristics. Results Over a median follow-up of 6.5 years, there were 3054 hospitalizations for serious infection. Infection incidence was lower for participants in the highest nSES quartile compared with the lowest quartile (11.7 vs 15.6 per 1000 person-years). After adjustment for demographics, comorbidities, and functional status, infection hazards were also lower for the highest quartile (HR, 0.84 [95% CI, .73-.97]), with a linear trend (P = .011). However, there was no association between nSES and sepsis at presentation among those hospitalized with infection. Physical weakness, income, and diabetes had modest mediating effects on the association of nSES with infection. Conclusions Our study shows that differential infection risk may explain nSES disparities in sepsis incidence, as higher nSES is associated with lower infection hospitalization rates, but there is no association with sepsis among those hospitalized. Mediation analysis showed that nSES may influence infection hospitalization risk at least partially through physical weakness, individual income, and comorbid diabetes.
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Affiliation(s)
- John P Donnelly
- Department of Emergency Medicine, University of Alabama School of Medicine.,Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Sindhu Lakkur
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Russell Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - George Howard
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Henry E Wang
- Department of Emergency Medicine, University of Texas Health Science Center at Houston
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Ford JS, Tonorezos ES, Mertens AC, Hudson MM, Casillas J, Foster BM, Moskowitz CS, Smith SM, Chou JF, Buchanan G, Robison LL, Oeffinger KC. Barriers and facilitators of risk-based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Cancer 2019; 126:619-627. [PMID: 31626337 DOI: 10.1002/cncr.32568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Optimal risk-based survivor health care includes surveillance for late effects and education targeted at reducing or preventing risky health behaviors. Understanding the reasons for a lack of risk-based follow-up care is essential. METHODS Adult participants from the Childhood Cancer Survivor Study were surveyed about having a cancer-related visit in the past 2 years and the likelihood of having a cancer-related visit in the future. Additional factors thought to be related to the primary outcomes were also assessed. RESULTS Nine hundred seventy-five survivors completed the survey. Twenty-seven percent (95% confidence interval [CI], 24%-30%) had a cancer-related medical visit in the previous 2 years, and 41% (95% CI, 38%-44%) planned to have such a visit within the next 2 years. The likelihood of having had a cancer-related visit within the last 2 years was higher among survivors assigning greater importance to these visits (relative risk [RR], 1.2; 95% CI, 1.1-1.3), perceiving greater susceptibility to health problems (RR, 1.2; 95% CI, 1.1-1.3), having a moderate to life-threatening chronic health problem related to their cancer (RR, 2.1; 95% CI, 1.7-2.7), seeing a primary care provider for a cancer-related problem (RR, 1.3; 95% CI, 1.0-1.6), having a cancer treatment summary (RR, 1.3; 95% CI, 1.0-1.6), and endorsing greater confidence in physicians' abilities to address questions and concerns (RR, 1.2; 95% CI, 1.0-1.3). CONCLUSIONS Educational interventions improving awareness of treatment history and susceptibility to cancer-related late effects and corresponding risk-based care are likely to be beneficial for survivors of childhood cancers.
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Affiliation(s)
- Jennifer S Ford
- Hunter College and Graduate Center, City University of New York, New York, New York
| | | | - Ann C Mertens
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Jacqueline Casillas
- University of California Los Angeles School of Medicine, Los Angeles, California
| | | | | | | | - Joanne F Chou
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - George Buchanan
- University of Texas Southwestern Medical Center, Dallas, Texas
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Abstract
BACKGROUND Patients with little or no health insurance are frequently readmitted to the hospital, yet few previous studies have listened to patients' explanations of why they returned to the hospital after discharge. Enhanced understanding of patient perspectives may facilitate targeted services and improve care. METHODS We enrolled 18 patients with Medicaid or no insurance during a hospital readmission within 30 days in a major metropolitan area, and conducted semi-structured qualitative interviews to explore the impact of patients' experiences around readmission using a grounded theory approach. RESULTS We identified five themes contributing to readmission: (1) therapeutic misalignment; (2) accountability; (3) social fragility; (4) access failures; and (5) disease behavior. Medical conditions were complicated by social influences and insufficiently addressed by our health system. Patients understood the need to manage their own health but were unable to effectively execute care plans because of competing life demands and compromised relationships with health providers. CONCLUSIONS Our study using interviews of readmitted Medicaid and uninsured patients revealed complex illnesses complicated by social instability and health system failures. Improved patient-provider trust and shared decision-making, while addressing social determinants and expanding care coordination with community partners, provide opportunity to better meet patients' needs and decrease hospital readmission in high-risk patients.
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Managing Medication Cost Burden: A Qualitative Study Exploring Experiences of People with Disabilities in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173066. [PMID: 31450782 PMCID: PMC6747197 DOI: 10.3390/ijerph16173066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 11/17/2022]
Abstract
Despite the abundant literature on the burden of rising costs of prescription medications, there is limited research to explore how these costs affect people and the decisions they are forced to make within the context of disability. In this qualitative study we explored strategies adopted, factors influencing, and the impact of some of these strategies to manage the burden of medication cost among persons with disabilities. We interviewed 12 adults with spinal cord injuries living in Canada, using a general inductive approach to analyze the data. We found that before cutting back on medications due to costs, participants generally tried and sought help from the government, employers, and/or their prescribers to improve their drug coverage. The key factors that participants considered while making decisions on the strategies included the cost and perceived importance of medications, their financial status, other competing needs, and their relationship with the prescribers. While some of their efforts were successful, many participants were still not able to obtain their medications as prescribed. In those cases, patients resorted to rationing strategies such as cutting back on medications, other essential needs, or selling assets. These strategies had serious implications on their health, healthcare utilization, and quality of life.
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Thomas DM, Oken E, Rifas-Shiman SL, Téllez-Rojo M, Just A, Svensson K, Deierlein AL, Chandler-Laney PC, Miller RC, McNamara C, Phelan S, Yoshitani S, Butte NF, Redman LM. Do Women Know Their Prepregnancy Weight? Obesity (Silver Spring) 2019; 27:1161-1167. [PMID: 31149770 PMCID: PMC6834084 DOI: 10.1002/oby.22502] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 03/14/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Prepregnancy weight may not always be known to women. A model was developed to estimate prepregnancy weight from measured pregnancy weight. METHODS The model was developed and validated using participants from two studies (Project Viva, n = 301, model development; and Fit for Delivery [FFD], n = 401, model validation). Data from the third study (Programming Research in Obesity, Growth, Environment and Social Stressors [PROGRESS]), which included women from Mexico City, were used to demonstrate the utility of the newly developed model to objectively quantify prepregnancy weight. RESULTS The model developed from the Project Viva study validated well with low bias (R2 = 0.95; y = 1.02x - 0.69; bias = 0.68 kg; 95% CI: -4.86 to 6.21). Predictions in women from FFD demonstrated good agreement (R2 = 0.96; y = 0.96x + 4.35; bias = 1.60 kg; 95% CI: -4.40 to 7.54; error range = -11.25 kg to 14.73 kg). High deviations from model predictions were observed in the Programming Research in PROGRESS (R2 = 0.81; y = 0.89x + 9.61; bias = 2.83 kg; 95% CI: -7.70 to 12.31; error range = -39.17 kg to 25.73 kg). The model was programmed into software (https://www.pbrc.edu/research-and-faculty/calculators/prepregnancy/). CONCLUSIONS The developed model provides an alternative to determine prepregnancy weight in populations receiving routine health care that may not have accurate knowledge of prepregnancy weight. The software can identify misreporting and classification into incorrect gestational weight gain categories.
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Affiliation(s)
- Diana M Thomas
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Martha Téllez-Rojo
- Program Evaluation and Biostatistics, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Allan Just
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Katherine Svensson
- Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Richard C Miller
- Department of Obstetrics and Gynecology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | | | - Suzanne Phelan
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, California, USA
| | - Shaw Yoshitani
- Department of Mathematical Sciences, United States Military Academy, West Point, New York, USA
| | - Nancy F Butte
- USDA/Agricultural Research Service, Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Leanne M Redman
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
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Langford AT, Wang B, Orzeck-Byrnes NA, Aidasani SR, Hu L, Applegate M, Moloney DN, Sevick MA, Rogers ES, Levy NK. Sociodemographic and clinical correlates of key outcomes from a Mobile Insulin Titration Intervention (MITI) for medically underserved patients. PATIENT EDUCATION AND COUNSELING 2019; 102:520-527. [PMID: 30293934 DOI: 10.1016/j.pec.2018.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/14/2018] [Accepted: 09/15/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID). OBJECTIVE To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID. METHODS Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes. RESULTS The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD = 10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p < .05). CONCLUSIONS Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs. PRACTICAL IMPLICATIONS Basic cell phone technology can be used to adjust patients' insulin remotely, thereby reducing logistical barriers to care.
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Affiliation(s)
| | - Binhuan Wang
- NYU School of Medicine, Department of Population Health, USA
| | | | | | - Lu Hu
- NYU School of Medicine, Department of Population Health, USA
| | | | | | - Mary Ann Sevick
- NYU School of Medicine, Department of Population Health, USA
| | - Erin S Rogers
- NYU School of Medicine, Department of Population Health, USA
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Weber A, Harrison TM. Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes. Nurs Outlook 2019; 67:169-189. [PMID: 30611546 PMCID: PMC6450772 DOI: 10.1016/j.outlook.2018.11.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 10/27/2018] [Accepted: 11/16/2018] [Indexed: 02/08/2023]
Abstract
In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati College of Nursing, 310 Proctor Hall, 3110 Vine St, Cincinnati, OH 45221, USA
| | - Tondi M. Harrison
- The Ohio State University, Newton Hall, College of Nursing, 1585 Neil Avenue, Columbus OH, 43210 USA
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Hugar LA, Yabes JG, Turner RM, Fam MM, Appleman LJ, Davies BJ, Jacobs BL. Rate and Determinants of Completing Neoadjuvant Chemotherapy in Medicare Beneficiaries With Bladder Cancer: A SEER-Medicare Analysis. Urology 2019; 124:191-197. [DOI: 10.1016/j.urology.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/10/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
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65
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Gutierrez CM. The Institutional Determinants of Health Insurance: Moving Away from Labor Market, Marriage, and Family Attachments under the ACA. AMERICAN SOCIOLOGICAL REVIEW 2018; 83:1144-1170. [PMID: 35572763 PMCID: PMC9098124 DOI: 10.1177/0003122418811112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
For more than a century, the American welfare state required working-age adults to obtain social welfare benefits through their linkages to employers, spouses, or children. Recent changes to U.S. healthcare policy prompted by the Patient Protection and Affordable Care Act (ACA), however, provide adults with new pathways for accessing a key form of social welfare-health insurance-decoupled from employers, spouses, and children. Taking advantage of this fundamental shift in the country's system of social welfare provision, I use data from the National Survey on Drug Use and Health (NSDUH) to explore patterns of health insurance coverage from before and after the ACA became active in 2014. The results show that the salience of labor market, marriage, and family attachments as pathways to coverage significantly declined in the first three years following passage of the ACA. By providing adults with a new route to coverage decoupled from their institutional attachments, the ACA helped narrow health insurance inequalities across gender, race and ethnicity, and education. Given the strong association between health insurance and health outcomes, the results from this study raise important questions about the centrality of institutional attachments for our knowledge of health inequalities.
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66
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Ramey SJ, Rich BJ, Kwon D, Mellon EA, Wolfson A, Portelance L, Yechieli R. Demographic disparities in delay of definitive chemoradiation for anal squamous cell carcinoma: a nationwide analysis. J Gastrointest Oncol 2018; 9:1109-1126. [PMID: 30603130 PMCID: PMC6286932 DOI: 10.21037/jgo.2018.08.07] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prolonged time to treatment initiation (TTI) for patients with curable anal cancer may reduce tumor control. This study investigated demographic disparities in TTI for patients receiving definitive chemoradiation (CRT) for anal squamous cell carcinoma (A-SCC). METHODS Adult patients with A-SCC diagnosed from 2004 to 2014 and treated with definitive CRT were identified in the National Cancer Database (NCDB). TTI was defined as days from diagnosis to start of CRT. A negative binomial regression model estimated predicted TTI (pTTI) values. Cox proportional hazards model evaluated the impact of TTI on overall survival (OS). RESULTS Overall, 12,546 patients were included with 9% Non-Hispanic Black patients and 4% Hispanic patients. Multivariable analysis (MVA) showed that pTTI varied significantly by race/ethnicity with Non-Hispanic Black patients having a pTTI of 50 vs. 38 days for Non-Hispanic White patients [relative risk (RR), 1.21; 95% confidence interval (CI), 1.17-1.25]. For Hispanic patients, pTTI was 48 days, significantly longer than that of Non-Hispanic White patients (RR, 1.19; 95% CI, 1.14-1.24). Gender, insurance status, education level, urban category, distance to reporting facility, treatment facility type, intensity-modulated radiation therapy (IMRT)/proton use, T/N classification, and comorbidity status were all also associated with significant variation in TTI. TTI was not independently associated with changes in OS on MVA [hazard ratio (HR), 0.999; 95% CI, 0.997-1.002]. CONCLUSIONS Non-Hispanic Black and Hispanic patients have longer delays in starting definitive CRT for A-SCC. While TTI was not associated with OS, future analyses should explore the impact of TTI on local control, metastases, and patient-reported outcomes.
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Affiliation(s)
- Stephen J. Ramey
- Department of Radiation Oncology, Georgia Cancer Center, Augusta University, Augusta, Georgia, USA
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Benjamin J. Rich
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Deukwoo Kwon
- Biostatistics and Bioinformatics Core, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Eric A. Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Aaron Wolfson
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Lorraine Portelance
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
| | - Raphael Yechieli
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center/University of Miami Miller School of Medicine, Miami, USA
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Self-Identified Social Determinants of Health during Transitions of Care in the Medically Underserved: a Narrative Review. J Gen Intern Med 2018; 33:1959-1967. [PMID: 30128789 PMCID: PMC6206338 DOI: 10.1007/s11606-018-4615-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/15/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Medically underserved or low socioeconomic status (SES) patients face significant vulnerability and a high risk of adverse events following hospital discharge. The environmental, social, and economic factors, otherwise known as social determinants, that compound this risk have been ineffectually described in this population. As the underserved comprise 30% of patients discharged from the hospital, improving transitional care and preventing readmission in this group has profound quality of care and financial implications. METHOD EMBASE and MEDLINE searches were conducted to examine specific barriers to care transitions in underserved patients following an episode of acute care. Articles were reviewed for barriers and categorized within the context of five general themes. RESULTS This review yielded 17 peer-reviewed articles. Common factors affecting care transitions were cost of medications, access to care, housing instability, and transportation. When categorized within themes, social fragility and access failures, as well as therapeutic misalignment, disease behavior, and issues with accountability were noted. DISCUSSION Providers and health systems caring for medically underserved patients may benefit through dedicating increased resources and broadening collaboration with community partners in order to expand health care access and enhance coordination of social services within this population. Future studies are needed to identify potential interventions targeting underserved patients to improve their post-hospital care.
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68
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Giannitrapani KF, Huynh AK, Schweizer CA, Hamilton AB, Hoggatt KJ. Patient-centered substance use disorder treatment for women Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Karleen F. Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Alexis K. Huynh
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - C. Amanda Schweizer
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, California, USA
| | - Katherine J. Hoggatt
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
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Almalki ZS, Karami NA, Almsoudi IA, Alhasoun RK, Mahdi AT, Alabsi EA, Alshahrani SM, Alkhdhran ND, Alotaib TM. Patient-centered medical home care access among adults with chronic conditions: National Estimates from the medical expenditure panel survey. BMC Health Serv Res 2018; 18:744. [PMID: 30261881 PMCID: PMC6161358 DOI: 10.1186/s12913-018-3554-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Patient-Centered Medical Home (PCMH) model is a coordinated-care model that has served as a means to improve several chronic disease outcomes and reduce management costs. However, access to PCMH has not been explored among adults suffering from chronic conditions in the United States. Therefore, the aim of this study was to describe the changes in receiving PCMH among adults suffering from chronic conditions that occurred from 2010 through 2015 and to identify predisposing, enabling, and need factors associated with receiving a PCMH. METHODS A cross-sectional analysis was conducted for adults with chronic conditions, using data from the 2010-2015 Medical Expenditure Panel Surveys (MEPS). Most common chronic conditions in the United States were identified by using the most recent data published by the Agency for Healthcare Research and Quality (AHRQ). The definition established by the AHRQ was used as the basis to determine whether respondents had access to PCMH. Multivariate logistic regression analyses were conducted to detect the association between the different variables and access to PCMH care. RESULTS A total of 20,403 patients with chronic conditions were identified, representing 213.7 million U.S. lives. Approximately 19.7% of the patients were categorized as the PCMH group at baseline who met all the PCMH criteria defined in this paper. Overall, the percentage of adults with chronic conditions who received a PCMH decreased from 22.3% in 2010 to 17.8% in 2015. The multivariate analyses revealed that several subgroups, including individuals aged 66 and older, separated, insured by public insurance or uninsured, from low-income families, residing in the South or the West, and with poor health, were less likely to have access to PCMH. CONCLUSION Our findings showed strong insufficiencies in access to a PCMH between 2010 and 2015, potentially driven by many factors. Thus, more resources and efforts need to be devoted to reducing the barriers to PCMH care which may improve the overall health of Americans with chronic conditions.
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Affiliation(s)
- Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia.
| | - Nedaa A Karami
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imtinan A Almsoudi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Roaa K Alhasoun
- College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Alaa T Mahdi
- Department of Pharmaceutical Science, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Entesar A Alabsi
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Saad M Alshahrani
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Nourah D Alkhdhran
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Tahani M Alotaib
- College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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George S, Daniels K, Fioratou E. A qualitative study into the perceived barriers of accessing healthcare among a vulnerable population involved with a community centre in Romania. Int J Equity Health 2018; 17:41. [PMID: 29615036 PMCID: PMC5883264 DOI: 10.1186/s12939-018-0753-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background Minority vulnerable communities, such as the European Roma, often face numerous barriers to accessing healthcare services, resulting in negative health outcomes. Both these barriers and outcomes have been reported extensively in the literature. However, reports on barriers faced by European non-Roma native communities are limited. The “Health Care Access Barriers” (HCAB) model identifies pertinent financial, structural and cognitive barriers that can be measured and potentially modified. The present study thus aims to explore the barriers to accessing healthcare for a vulnerable population of mixed ethnicity from a charity community centre in Romania, as perceived by the centre’s family users and staff members, and assess whether these reflect the barriers identified from the HCAB model. Methods Eleven community members whose children attend the centre and seven staff members working at the centre participated in face-to-face semi-structured interviews, exploring personal experiences and views on accessing healthcare. The interviews were transcribed and analysed using an initial deductive and secondary inductive approach to identify HCAB themes and other emerging themes and subthemes. Results Identified themes from both groups aligned with HCAB’s themes of financial, structural and cognitive barriers and emergent subthemes important to the specific population were identified. Specifically, financial barriers related mostly to health insurance and bribery issues, structural barriers related mostly to service availability and accessibility, and cognitive barriers related mostly to healthcare professionals’ attitudes and discrimination and the vulnerable population’s lack of education and health literacy. A unique theme of psychological barriers emerged from both groups with associated subthemes of mistrust, hopelessness, fear and anxiety of this vulnerable population. Conclusion The current study highlights healthcare access barriers to a vulnerable non-Roma native population involved with a charity community centre in Romania. The “Healthcare Access Barriers for Vulnerable Populations” (HABVP) model is proposed as an adaption to the existing HCAB model to account for the unique perceived barriers to healthcare for this population. Recommendations for future resolution of these identified barriers are proposed. Electronic supplementary material The online version of this article (10.1186/s12939-018-0753-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Siân George
- University of Dundee, School of Medicine, Dundee, Scotland, UK
| | - Katy Daniels
- General Practitioner and Clinical Teacher, University of Dundee, School of Medicine, The Mackenzie Building, Kirsty Semple Way, Dundee, DD2 4BF, UK
| | - Evridiki Fioratou
- University of Dundee, Ninewells Hospital & Medical School, Level 7, Room 003A (Lab Block, Corridor A), Mailbox 11, Dundee, DD1 9SY, UK.
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Meador M, Osheroff JA, Reisler B. Improving Identification and Diagnosis of Hypertensive Patients Hiding in Plain Sight (HIPS) in Health Centers. Jt Comm J Qual Patient Saf 2018; 44:117-129. [PMID: 29499808 DOI: 10.1016/j.jcjq.2017.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/11/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Hypertension is the most prevalent chronic condition diagnosed among patients served in the safety net in the United States; however, many safety-net patients with hypertension are not formally diagnosed and may remain untreated and at increased risk for cardiovascular events. Identifying undiagnosed hypertension using algorithmic logic programmed into clinical decision support (CDS) approaches is a promising practice but has not been broadly tested in the safety-net setting. METHODS The project used a quality improvement approach wherein information flows and actions related to blood pressure measurement were modified to include algorithm criteria to identify patients who might have undiagnosed hypertension. Identified patients were recalled for evaluation and hypertension diagnosis, if appropriate. Ten health centers in Arkansas, California, Kentucky, and Missouri were selected to participate in the project on the basis of high hypertension prevalence (compared to national average), demographic and geographic diversity, mature information systems infrastructure, and executive support. The project targeted patients from 18 to 85 years of age. RESULTS After implementation of algorithm-based interventions, diagnosed hypertension prevalence increased significantly from 34.5% to 36.7% (p <0.05). A cohort of patients was tracked from 8 of the 10 health centers to assess follow-up evaluation and diagnosis rates; 65.2% completed a follow-up evaluation, of which 31.9% received a hypertension diagnosis. CONCLUSION Using algorithmic logic and other CDS-enabled care process improvements appears to be an effective way health centers can identify and engage patients at risk for undiagnosed hypertension. Appropriately diagnosing all hypertensive patients ensures that hypertension control efforts yield maximal improvements in population health.
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Enticott JC, Lin E, Shawyer F, Russell G, Inder B, Patten S, Meadows G. Prevalence of psychological distress: How do Australia and Canada compare? Aust N Z J Psychiatry 2018; 52:227-238. [PMID: 28523939 DOI: 10.1177/0004867417708612] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare equivalent population-level mental health indicators in Canada and Australia, and articulate recommendations to support equitable mental health services. These are two somewhat similar resource-rich countries characterized by extensive non-metropolitan and rural regions as well as significant areas of socioeconomic deprivation. METHODS A cross-national epidemiology and equity study: primary outcome was Kessler Psychological Distress Scale (K10) in recent national surveys. A secondary outcome was mental disorders rate since these surveys were 5-years apart. RESULTS Elevated distress, defined by K10 scores (0-40 range) of 12 and over, affected 11.1% Australians and 12.0% Canadians. Elevated distress in both countries affected more people in the lowest income quintile (21-27%) compared to the richest (6%). In the lowest income quintile, 1-in-4 Australians and 1-in-5 Canadians reported elevated distress - twice the national average in both countries. Australians in the lowest income quintile (over 5 million people) have a significantly higher risk by over a 5% for elevated distress compared to their low-income Canadian counterparts. After adjusting for effects of age and gender, the relative odds in the lowest quintile compared to richest was 6.4 for Australians and 3.5 for Canadians, which remained significantly different thus confirming greater inequity in Australia. Mental disorders affected approximately 1-in-10 people in both countries. CONCLUSIONS This adds to the mental health prevalence monitoring in these two countries by supporting an overall prevalence of elevated distress in approximately 1-in-10 people. It supports large-scale public health interventions that target elevated distress in people with low incomes to order to achieve the biggest impact, and, to reduce the greater inequity in mental health indicators in Australians, policy-makers should consider eliminating gap-fees as they are illegal in Canada. As encouraged by World Health Organization, we highlight the importance of such population-level studies so that cross-national results can be reliably compared.
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Affiliation(s)
- Joanne C Enticott
- 1 Southern Synergy, Department of Psychiatry, Monash University, Dandenong, VIC, Australia.,2 Royal District Nursing Service Institute, St Kilda, VIC, Australia
| | - Elizabeth Lin
- 3 Center for Addiction and Mental Health (CAMH), Toronto, ON, Canada.,4 University of Toronto, Toronto, ON, Canada.,5 Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Frances Shawyer
- 1 Southern Synergy, Department of Psychiatry, Monash University, Dandenong, VIC, Australia
| | - Grant Russell
- 6 School of Primary and Allied Health Care, Monash University, Melbourne, VIC, Australia.,7 Southern Academic Primary Care Research Unit, Monash University, Melbourne, VIC, Australia.,8 Department of Family Medicine, University of Ottawa, ON, Canada
| | - Brett Inder
- 9 Department of Econometrics and Business Statistics, Monash University, Melbourne, VIC, Australia
| | | | - Graham Meadows
- 1 Southern Synergy, Department of Psychiatry, Monash University, Dandenong, VIC, Australia.,11 Monash Health, Melbourne, VIC, Australia.,12 Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
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Sum G, Hone T, Atun R, Millett C, Suhrcke M, Mahal A, Koh GCH, Lee JT. Multimorbidity and out-of-pocket expenditure on medicines: a systematic review. BMJ Glob Health 2018; 3:e000505. [PMID: 29564155 PMCID: PMC5859814 DOI: 10.1136/bmjgh-2017-000505] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background Multimorbidity, the presence of two or more non-communicable diseases (NCD), is a costly and complex challenge for health systems globally. Patients with NCDs incur high levels of out-of-pocket expenditure (OOPE), often on medicines, but the literature on the association between OOPE on medicines and multimorbidity has not been examined systematically. Methods A systematic review was conducted via searching medical and economics databases including Ovid Medline, EMBASE, EconLit, Cochrane Library and the WHO Global Health Library from year 2000 to 2016. Study quality was assessed using Newcastle-Ottawa Scale. PROSPERO: CRD42016053538. Findings 14 articles met inclusion criteria. Findings indicated that multimorbidity was associated with higher OOPE on medicines. When number of NCDs increased from 0 to 1, 2 and ≥3, annual OOPE on medicines increased by an average of 2.7 times, 5.2 times and 10.1 times, respectively. When number of NCDs increased from 0 to 1, 2, ≥2 and ≥3, individuals spent a median of 0.36% (IQR 0.15%–0.51%), 1.15% (IQR 0.62%–1.64%), 1.41% (IQR 0.86%–2.15%), 2.42% (IQR 2.05%–2.64%) and 2.63% (IQR 1.56%–4.13%) of mean annual household net adjusted disposable income per capita, respectively, on annual OOPE on medicines. More multimorbidities were associated with higher OOPE on medicines as a proportion of total healthcare expenditures by patients. Some evidence suggested that the elderly and low-income groups were most vulnerable to higher OOPE on medicines. With the same number of NCDs, certain combinations of NCDs yielded higher medicine OOPE. Non-adherence to medicines was a coping strategy for OOPE on medicines. Conclusion Multimorbidity of NCDs is increasingly costly to healthcare systems and OOPE on medicines can severely compromise financial protection and universal health coverage. It is crucial to recognise the need for better equity and financial protection, and policymakers should consider health system financial options, cost sharing policies and service patterns for those with NCD multimorbidities.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Rifat Atun
- Harvard T.H Chan, School of Public Health, and Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK
| | - Marc Suhrcke
- Centre for Health Economics, University of York, England, UK.,Luxembourg Institute for Socio-economic Research, Luxembourg, Europe
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, UK.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Soares N, Dewalle J, Marsh B. Utilizing patient geographic information system data to plan telemedicine service locations. J Am Med Inform Assoc 2018; 24:891-896. [PMID: 28339932 DOI: 10.1093/jamia/ocx011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/26/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To understand potential utilization of clinical services at a rural integrated health care system by generating optimal groups of telemedicine locations from electronic health record (EHR) data using geographic information systems (GISs). Methods This retrospective study extracted nonidentifiable grouped data of patients over a 2-year period from the EHR, including geomasked locations. Spatially optimal groupings were created using available telemedicine sites by calculating patients' average travel distance (ATD) to the closest clinic site. Results A total of 4027 visits by 2049 unique patients were analyzed. The best travel distances for site groupings of 3, 4, 5, or 6 site locations were ranked based on increasing ATD. Each one-site increase in the number of available telemedicine sites decreased minimum ATD by about 8%. For a given group size, the best groupings were very similar in minimum travel distance. There were significant differences in predicted patient load imbalance between otherwise similar groupings. A majority of the best site groupings used the same small number of sites, and urban sites were heavily used. Discussion With EHR geospatial data at an individual patient level, we can model potential telemedicine sites for specialty access in a rural geographic area. Relatively few sites could serve most of the population. Direct access to patient GIS data from an EHR provides direct knowledge of the client base compared to methods that allocate aggregated data. Conclusion Geospatial data and methods can assist health care location planning, generating data about load, load balance, and spatial accessibility.
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Affiliation(s)
- Neelkamal Soares
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Joseph Dewalle
- Environmental Health Institute, Center for Health Research, Geisinger Health System, Danville, PA, USA
| | - Ben Marsh
- Department of Geography and Program in Environmental Studies, Bucknell University, Lewisburg, PA, USA
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Inequalities in Health Services Usage in a National Health System Scheme: The Case of a Southern Social European Region. Nurs Res 2017; 67:26-34. [PMID: 29240657 DOI: 10.1097/nnr.0000000000000256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health services can reduce inequalities caused by other determinants of health or increase them due to the effect of the inverse care law-the principle that the availability of good quality care tends to vary inversely with the need for it in the population served. OBJECTIVE The purpose of the research was to describe inequalities in the use of nursing services, medical services in primary care, specialist care, and services not fully covered by the Basque public health system in Spain. METHODS A cross-sectional study of adults aged at least 25 years who completed the 2013 Basque Health Survey (N = 10,454) was conducted. Age-standardized prevalence and prevalence ratios for use of services that are covered and noncovered in the health system were computed. The association of health services usage with socioeconomic variables was estimated using a Poisson regression model with robust variance. The relative index of inequality (RII) was used to measure the magnitude of socioeconomic status inequalities in health service use. All analyses were carried out separately for men and women. RESULTS Individuals with lower socioeconomic status were more likely to use primary care (RII = 0.87, 95% CI [0.79, 0.97]) and less likely to use specialist services (RII = 0.82, 95% CI [0.75, 0.89]). Across noncovered health services, inequalities between the highest and lowest social groups were significant in all cases and especially marked in men's use of physiotherapists (RII = 0.46, 95% CI [0.35, 0.61]) and podiatrists (RII = 0.24, 95%CI [0.15, 0.38]). DISCUSSION There are significant inequalities in primary and specialist health service use based on individual socioeconomic status, particularly for services that are not provided free of charge within the existing health system. This suggests that health service systems that are not explicitly designed to provide universal access may actually amplify preexisting social and health inequalities within their target populations.
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Gundewar A, David R, Frey SM, Fagnano M, Halterman JS. Underutilization of Preventive Asthma Visits Among Urban Children With Persistent Asthma. Clin Pediatr (Phila) 2017; 56:1312-1318. [PMID: 28155330 PMCID: PMC6085754 DOI: 10.1177/0009922816685816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
National guidelines recommend that children with persistent asthma have at least 2 preventive asthma visits (PAVs) per year. We sought to determine the percent of urban children with persistent asthma who had a PAV in the past year, and to identify differences in demographics, health-related variables, and management associated with PAVs. Using data from 530 children (3-10 years) participating in a school-based asthma trial, we found that only 25% of children had at least 1 PAV, with only 5% receiving ≥2 visits. Having a PAV was not associated with demographics or health-related variables. Importantly, having a PAV was associated with having a preventive medication, taking that medication daily, and having a medication adjustment. Although PAVs were associated with actions to improve asthma control and management, these visits were underutilized in this sample. This highlights the need for novel methods to ensure access and deliver care to this vulnerable pediatric population.
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Affiliation(s)
- Anisha Gundewar
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Rebecca David
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Sean M. Frey
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Maria Fagnano
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Jill S. Halterman
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Segan JD, Briggs AM, Chou L, Connelly KL, Seneviwickrama M, Sullivan K, Cicuttini FM, Wluka AE. Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review. Semin Arthritis Rheum 2017; 47:765-777. [PMID: 29174791 DOI: 10.1016/j.semarthrit.2017.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 09/04/2017] [Accepted: 10/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Care that is patient-centred is more likely to be sustainable and associated with improved health outcomes. This approach to care requires an understanding of patients' health service needs, yet few studies have directly investigated the perceived health service needs of people with inflammatory arthritis. OBJECTIVES To systematically identify the existing literature relating to patient perceived health service needs for inflammatory arthritis. METHODS A systematic review of MEDLINE, EMBASE, CINAHL, and PsycINFO was conducted (1990-2016). Studies examining patients' perceived needs relating to health services for inflammatory arthritis were identified. Descriptive data regarding study design and methodology were extracted and risk of bias assessed. Findings were collated and categorized thematically. RESULTS In total, 27 of 1405 (16 qualitative, 9 quantitative, and 2 mixed-methods) studies were relevant. The main areas of perceived need related to (1) Communication: consumers wanted clear, empathic communication, and to be involved with decision-making. (2) Characteristics of ongoing care: adequate consultation length with continuity and timely care were valued. (3) Factors influencing care-seeking included individual attitudes, disease severity, finances and family expectations. (4) Allied health and complementary and alternative medicines (CAM) were perceived as useful by many. The reporting of CAM use to doctors was variable, with several factors contributing to under-reporting. CONCLUSIONS This review identified patients' perceived needs for better communication with their health providers, the heterogeneity of influences determining when care is sought and preferences regarding non-pharmacologic therapies. Aligning patients' perceived needs with evidence-based therapy for people with inflammatory arthritis will be important in optimizing patient outcomes.
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Affiliation(s)
- Julian D Segan
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia; MOVE: Muscle, Bone & Joint Health, Victoria, Australia
| | - Louisa Chou
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Kathryn L Connelly
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Maheeka Seneviwickrama
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Kaye Sullivan
- Monash University Library, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Commercial Rd, Victoria 3004, Melbourne, Australia.
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Yu SWY, Hill C, Ricks ML, Bennet J, Oriol NE. The scope and impact of mobile health clinics in the United States: a literature review. Int J Equity Health 2017; 16:178. [PMID: 28982362 PMCID: PMC5629787 DOI: 10.1186/s12939-017-0671-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/24/2017] [Indexed: 11/24/2022] Open
Abstract
As the U.S. healthcare system transforms its care delivery model to increase healthcare accessibility and improve health outcomes, it is undergoing changes in the context of ever-increasing chronic disease burdens and healthcare costs. Many illnesses disproportionately affect certain populations, due to disparities in healthcare access and social determinants of health. These disparities represent a key area to target in order to better our nation's overall health and decrease healthcare expenditures. It is thus imperative for policymakers and health professionals to develop innovative interventions that sustainably manage chronic diseases, promote preventative health, and improve outcomes among communities disenfranchised from traditional healthcare as well as among the general population. This article examines the available literature on Mobile Health Clinics (MHCs) and the role that they currently play in the U.S. healthcare system. Based on a search in the PubMed database and data from the online collaborative research network of mobile clinics MobileHealthMap.org , the authors evaluated 51 articles with evidence on the strengths and weaknesses of the mobile health sector in the United States. Current literature supports that MHCs are successful in reaching vulnerable populations, by delivering services directly at the curbside in communities of need and flexibly adapting their services based on the changing needs of the target community. As a link between clinical and community settings, MHCs address both medical and social determinants of health, tackling health issues on a community-wide level. Furthermore, evidence suggest that MHCs produce significant cost savings and represent a cost-effective care delivery model that improves health outcomes in underserved groups. Even though MHCs can fulfill many goals and mandates in alignment with our national priorities and have the potential to help combat some of the largest healthcare challenges of this era, there are limitations and challenges to this healthcare delivery model that must be addressed and overcome before they can be more broadly integrated into our healthcare system.
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Affiliation(s)
- Stephanie W. Y. Yu
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Rd, Pokfulam, Hong Kong, Special Administrative Region of China
| | - Caterina Hill
- Department of Global Health and Social Medicine, Harvard Medical School, c/o The Family Van, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Mariesa L. Ricks
- Harvard Business School, Soldiers Field, Boston, MA 02163 USA
- Harvard University T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - Jennifer Bennet
- The Family Van: Harvard Medical School, 1542 Tremont St, Roxbury, MA 02120 USA
| | - Nancy E. Oriol
- Harvard Medical School, 260 Longwood Ave, Suite 244, Boston, MA 02115 USA
- Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA
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Kramer MR, Schneider EB, Kane JB, Margerison-Zilko C, Jones-Smith J, King K, Davis-Kean P, Grzywacz JG. Getting Under the Skin: Children's Health Disparities as Embodiment of Social Class. POPULATION RESEARCH AND POLICY REVIEW 2017; 36:671-697. [PMID: 29398742 PMCID: PMC5791911 DOI: 10.1007/s11113-017-9431-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
Social class gradients in children's health and development are ubiquitous across time and geography. The authors develop a conceptual framework relating three actions of class-material allocation, salient group identity, and inter-group conflict-to the reproduction of class-based disparities in child health. A core proposition is that the actions of class stratification create variation in children's mesosystems and microsystems in distinct locations in the ecology of everyday life. Variation in mesosystems (e.g., health care, neighborhoods) and microsystems (e.g., family structure, housing) become manifest in a wide variety of specific experiences and environments that produce the behavioral and biological antecedents to health and disease among children. The framework is explored via a review of theoretical and empirical contributions from multiple disciplines and high-priority areas for future research are highlighted.
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Affiliation(s)
- Michael R Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322
| | - Eric B Schneider
- Department of Economic History, London School of Economics and Political Science
| | | | - Claire Margerison-Zilko
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University
| | - Jessica Jones-Smith
- Department of International Health, Johns Hopkins Bloomberg School of Public Health
| | - Katherine King
- Department of Community and Family Medicine, Duke University
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80
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Brooks TA. Despite Boosting Children's Coverage Rates To Historic Levels, Medicaid And CHIP Face An Uncertain Future. Health Aff (Millwood) 2017; 36:1652-1655. [PMID: 28874494 DOI: 10.1377/hlthaff.2017.0929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Children's Health Insurance Program (CHIP), which was enacted twenty years ago, covers uninsured children who do not qualify for Medicaid but lack access to affordable coverage. Together these safety-net programs have boosted the health insurance coverage rate among US children to historic levels, exceeding 95 percent of children in 2015. However, the future of both CHIP and Medicaid is uncertain. In the current congressional debate over the Affordable Care Act, Medicaid has become a target for potential funding reductions and other changes that would undermine the scope of children's coverage. Congress has yet to act to extend CHIP funding beyond September 30, 2017, when the current appropriation expires. State and federal policy makers should act now to preserve the foundation of coverage currently in place while striving to ensure that every child in the United States has health coverage.
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Affiliation(s)
- Tricia A Brooks
- Tricia A. Brooks is a senior fellow at the Georgetown University Center for Children and Families in the university's McCourt School of Public Policy, in Washington, D.C. She is a former Children's Health Insurance Program (CHIP) director in New Hampshire
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Andreatos N, Grigoras C, Shehadeh F, Pliakos EE, Stoukides G, Port J, Flokas ME, Mylonakis E. The impact of HIV infection and socioeconomic factors on the incidence of gonorrhea: A county-level, US-wide analysis. PLoS One 2017; 12:e0183938. [PMID: 28863154 PMCID: PMC5580927 DOI: 10.1371/journal.pone.0183938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Gonorrhea is the second most commonly reported identifiable disease in the United States (U.S.). Importantly, more than 25% of gonorrheal infections demonstrate antibiotic resistance, leading the Centers for Disease Control and Prevention (CDC) to classify gonorrhea as an “urgent threat”. Methods We examined the association of gonorrhea infection rates with the incidence of HIV and socioeconomic factors. A county-level multivariable model was then constructed. Results Multivariable analysis demonstrated that HIV incidence [Coefficient (Coeff): 1.26, 95% Confidence Interval (CI): 0.86, 1.66, P<0.001] exhibited the most powerful independent association with the incidence of gonorrhea and predicted 40% of the observed variation in gonorrhea infection rates. Sociodemographic factors like county urban ranking (Coeff: 0.12, 95% CI: 0.03, 0.20, P = 0.005), percentage of women (Coeff: 0.41, 95% CI: 0.28, 0.53, P<0.001) and percentage of individuals under the poverty line (Coeff: 0.45, 95% CI: 0.32, 0.57, P<0.001) exerted a secondary impact. A regression model that incorporated these variables predicted 56% of the observed variation in gonorrhea incidence (Pmodel<0.001, R2 model = 0.56). Conclusions Gonorrhea and HIV infection exhibited a powerful correlation thus emphasizing the benefits of comprehensive screening for sexually transmitted infections (STIs) and the value of pre-exposure prophylaxis for HIV among patients visiting an STI clinic. Furthermore, sociodemographic factors also impacted gonorrhea incidence, thus suggesting another possible focus for public health initiatives.
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Affiliation(s)
- Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Christos Grigoras
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Georgianna Stoukides
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Jenna Port
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
- * E-mail:
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White Hughto JM, Rose AJ, Pachankis JE, Reisner SL. Barriers to Gender Transition-Related Healthcare: Identifying Underserved Transgender Adults in Massachusetts. Transgend Health 2017; 2:107-118. [PMID: 29082331 PMCID: PMC5627670 DOI: 10.1089/trgh.2017.0014] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose: The present study sought to examine whether individual (e.g., age, gender), interpersonal (e.g., healthcare provider discrimination), and structural (e.g., lack of insurance coverage) factors are associated with access to transition-related care in a statewide sample of transgender adults. Method: In 2013, 364 transgender residents of Massachusetts completed an electronic web-based survey online (87.1%) or in person (12.9%). A multivariable logistic regression model tested whether individual, interpersonal, and structural factors were associated with access to transition-related care. Results: Overall, 23.6% reported being unable to access transition-related care in the past 12 months. In a multivariable model, younger age, low income, low educational attainment, private insurance coverage, and healthcare discrimination were significantly associated with being unable to access transition-related care (all p<0.05). Discussion: Despite state nondiscrimination policies and universal access to healthcare, many of the Massachusetts transgender residents sampled were unable to access transition-related care. Multilevel interventions are needed, including supportive policies and policy enforcement, to ensure that underserved transgender adults can access medically necessary transition-related care.
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Affiliation(s)
- Jaclyn M. White Hughto
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Adam J. Rose
- RAND Corporation, Boston, Massachusetts
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - John E. Pachankis
- Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Sari L. Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Division of General Pediatrics/Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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83
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Caballero TM, DeCamp LR, Platt RE, Shah H, Johnson SB, Sibinga EMS, Polk S. Addressing the Mental Health Needs of Latino Children in Immigrant Families. Clin Pediatr (Phila) 2017; 56:648-658. [PMID: 27879297 DOI: 10.1177/0009922816679509] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Latino children in the United States, whether immigrants themselves or children in immigrant families, are at high risk for mental health disorders stemming from poverty, exposure to trauma, assimilation stressors, and discrimination. The timely identification and treatment of mental health disorders in Latino children are compromised by limited healthcare access and quality as well as the lack of routine mental health screening in pediatric primary care. Here we review Spanish-language validity and implementation studies of Bright Futures previsit mental health screening tools and models of care. We identify strengths and weaknesses in the literature and suggest tools for use in mental health care assessment, management, and treatment for Latino children in pediatric primary care. Pediatricians can improve care of Latino children through awareness of risk factors for mental health disorders, integration of evidence-based screening tools, and advocacy for culturally tailored mental health resources.
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Affiliation(s)
| | | | | | - Harita Shah
- 1 Johns Hopkins University, Baltimore, MD, USA
| | | | | | - Sarah Polk
- 1 Johns Hopkins University, Baltimore, MD, USA
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84
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Cama S, Malowney M, Smith AJB, Spottswood M, Cheng E, Ostrowsky L, Rengifo J, Boyd JW. Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 47:621-635. [DOI: 10.1177/0020731417707492] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. Providers were less likely to have available appointments for children on Medicaid, which is public insurance for low-income people. The most common reason for being unable to make an appointment was that the listed phone number was incorrect. Pediatricians were twice as likely to see new patients and to see them sooner than child psychiatrists. Increasing the number of both types of providers may be necessary to increase access to mental health care for children.
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Affiliation(s)
- Shireen Cama
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Anna Jo Bodurtha Smith
- Department of Obstetrics-Gynecology, Johns Hopkins Medical School, Baltimore, Maryland, USA
| | - Margaret Spottswood
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Elisa Cheng
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Louis Ostrowsky
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - J. Wesley Boyd
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Bioethics, Harvard Medical School, Boston, Massachusetts, USA
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Husaini B, Levine R, Lammers P, Hull P, Novotny M, Moonis M. Smoking, depression, and hospital costs of respiratory cancers: Examining race and sex variation. Fam Med Community Health 2017; 5:29-42. [PMID: 29057243 PMCID: PMC5648368 DOI: 10.15212/fmch.2017.0109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The role of smoking and depression relative to hospital cost for lung cancer (LC) remains unknown. METHODS We extracted data on depression, smoking history, demographics, and hospital charges on patients with respiratory cancers (ICD-9 codes 161-163,165) from the 2008 Tennessee Hospital Discharge Data System. The sample (n=6,665) was mostly white (86%) and male (57). Age-adjusted rates were developed per CDC methodology, and hospital costs were compared for LC with vs. without depression and smoking. RESULTS Three findings (p<.001) emerged: (i) LC rate was higher among blacks than whites, and higher among males than females; (ii) While 66% of LC smoked (more males than females without racial variation), 24% had depression (more females and whites were depressed); (iii) The LC hospital cost was 54% higher compared to non-LC, and this cost doubled for LC with depression and smoking vs. those without such characteristics. CONCLUSION While LC is more prevalent among blacks and males, depression is higher among female and white patients. Since depression with higher costs existed among LC patients, our findings point to: (i) possibility of cost savings by diagnosing and treating depression among LC, and (ii) implementing proven smoking cessation programs to reduce LC morbidity and hospital costs.
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Affiliation(s)
- Baqar Husaini
- Tennessee State University, Nashville, Tennessee 37209
| | | | | | - Pam Hull
- Vanderbilt University, Nashville, Tennessee 37240
| | | | - Majaz Moonis
- University of Massachusetts, Worcester, Massachusetts 01655
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Arpey NC, Gaglioti AH, Rosenbaum ME. How Socioeconomic Status Affects Patient Perceptions of Health Care: A Qualitative Study. J Prim Care Community Health 2017; 8:169-175. [PMID: 28606031 PMCID: PMC5932696 DOI: 10.1177/2150131917697439] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Clinician perceptions of patients with low socioeconomic status (SES) have been shown to affect clinical decision making and health care delivery in this group. However, it is unknown how and if low SES patients perceive clinician bias might affect their health care. Methods: In-depth interviews with 80 enrollees in a state Medicaid program were analyzed to identify recurrent themes in their perceptions of care. Results: Most subjects perceived that their SES affected their health care. Common themes included treatment provided, access to care, and patient-provider interaction. Discussion: This study highlights complex perceptions patients have around how SES affects their health care. These results offer opportunities to reduce health care disparities through better understanding of their impact on the individual patient-provider relationship. This work may inform interventions that promote health equity via a multifaceted approach, which targets both providers and the health care system as a whole.
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Affiliation(s)
- Nicholas C Arpey
- 1 University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Anne H Gaglioti
- 2 National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA, USA
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Abstract
Pre-participation physical exams (PPEs) hold great potential for addressing adolescents’ health-risk behaviors. School nurses may be well positioned to assist with PPEs, yet little is known about their involvement. In this mixed methods study conducted in 2015, we collected data from school nurses in Texas (surveys, n = 208; key informant interviews, n = 10) to explore their roles and attitudes toward being involved in PPEs and addressing health-risk behaviors. Most respondents described minimal involvement in PPEs or were not involved to their full scope of practice. Most (69%) felt that school nurses are an untapped resource for addressing health-risk behaviors among student athletes. Interview participants felt that student athletes saw nurses as a “safe space” to talk about health-risk behaviors. Barriers included a lack of time, resources for follow-up, parental approval, and legal concerns. Study findings identify potential opportunities to support nurses’ involvement in addressing health-risk behaviors among student athletes.
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Affiliation(s)
- Karen E. Johnson
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Marian Morris
- School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, MN, USA
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88
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Wright PM. Reducing health disparities for women through use of the medical home model. Contemp Nurse 2017; 53:126-131. [PMID: 28077044 DOI: 10.1080/10376178.2017.1281086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Healthcare services can be difficult to access, particularly for low-income or underinsured women. One way of overcoming the barriers to quality, patient-centered care is through the use of the Medical Home Model (MHM). The MHM is a cost-effective approach to care that improves patient outcomes and improves access. AIM The purpose of this article is to discuss barriers to healthcare, with an emphasis on reducing healthcare disparities for women. METHOD Extant, contemporary literature has been reviewed and synthesized to develop this theoretical paper on the benefits of using the MHM to reduce disparities in the provision of healthcare for women. CONCLUSIONS The MHM provides an example of how healthcare can be provided in a more coordinated and effective manner. Extension of this model into the area of women's health may be one way to reduce barriers to quality, accessible care for women.
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Affiliation(s)
- Patricia Moyle Wright
- a Department of Nursing , The University of Scranton , 800 Linden Street, Scranton , PA 18510 , USA
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Collins L, Smiley SL, Moore RA, Graham AL, Villanti AC. Physician tobacco screening and advice to quit among U.S. adolescents - National Survey on Drug Use and Health, 2013. Tob Induc Dis 2017; 15:2. [PMID: 28077940 PMCID: PMC5223531 DOI: 10.1186/s12971-016-0107-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background Initiating tobacco use in adolescence increases the risk of nicotine dependence and continued smoking. Physician screening for tobacco use increases the odds of physicians intervening with patients who smoke; However, without appropriate follow-through by the physician, screening for tobacco use is not enough to significantly increase cessation rates. Given the critical phase of development adolescence poses in tobacco use and evidence that physician intervention improves adult cessation efforts, we sought to examine physician tobacco use screening and advice to quit among adolescents (12–17 years). Methods Using data from the 2013 National Survey on Drug Use and Health (NSDUH), we examined the prevalence and correlates of tobacco use screening in adolescent respondents who reported visiting their physician within the past year (N = 12,798). Multivariable logistic regression analyses explored the relationship between tobacco use screening and physician advice to quit in a sub-set of the sample who reported on physician advice to quit (n = 1,868), controlling for sociodemographics, cigarette use, and substance use and screening. Results Only 49% of adolescents who visited a physician within the past year reported being screened for tobacco use. Adolescents who were screened by their physician were predominantly female (56.6%), White (60.1%), in late adolescence (83.0%), and covered by private health insurance (63.8%). Screening for tobacco use was highly correlated with physician advice to quit smoking, controlling for sociodemographic characteristics and cigarette use; this relationship was attenuated, but remained significant, after screening for alcohol and marijuana were added to the model. Hispanic adolescents were significantly less likely to receive physician advice to quit in all multivariable models. Conclusions Our findings suggest missed opportunities for youth tobacco use prevention and cessation efforts in the clinical setting. Further research is needed to better facilitate an open dialogue on tobacco use between physicians and their adolescent patients.
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Affiliation(s)
- Lauren Collins
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC USA
| | - Sabrina L Smiley
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC USA
| | - Rakiya A Moore
- Evaluation Science and Research at Truth Initiative, Washington, DC USA
| | - Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC USA ; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC USA
| | - Andrea C Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC USA ; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Abstract
Inspiration and innovation go hand in hand. Throughout history tragedies, including those personal and life altering, have inspired susceptible minds to find innovative ways to educate and tackle difficult problems. This address is first about origins. It weaves the story of how incredible individuals and events have shaped similar circumstances into not only our profession of pediatric surgery beginning with William E. Ladd, but also the emergency and trauma care system in this country. The address circles back to look at the past and future of our profession of pediatric surgery. Predictive models forecast that we are training too many pediatric surgeons in the traditional sense. The address describes how we might envision a paradigm shift in training using a different model and capitalizing on the talents of more young surgeons who want to take care of children. We are an incredible profession, but many have abdicated a need to include trauma patients and critical care in their practice of pediatric surgery. The model would include different pathways of training, enable more surgeons to be capable in aspects of children's surgical care, and provide optimal general surgical care for more children in the United States. This is an opportunity to redefine Ladd's path.
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Housten AJ, Furtado K, Kaphingst KA, Kebodeaux C, McBride T, Cusanno B, Politi MC. Stakeholders' perceptions of ways to support decisions about health insurance marketplace enrollment: a qualitative study. BMC Health Serv Res 2016; 16:634. [PMID: 27821121 PMCID: PMC5100320 DOI: 10.1186/s12913-016-1890-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background Approximately 29 million individuals are expected to enroll in health insurance using the Patient Protection and Affordable Care Act (ACA) Marketplace by 2022. Those seeking health insurance struggle to understand insurance options and choose a plan that best suits their needs. Methods We interviewed stakeholders to identify the challenges associated with the ACA Marketplace health insurance enrollment and elicited feedback about what to include in health insurance decision support tools. Interviews were transcribed and themes were identified using inductive thematic analysis. Results Stakeholders stated that consumers felt frustrated by unclear terminology, high plan costs, and complex calculations required to assess costs. Consumers felt anxious about making the wrong choice and being unable to change plans within a calendar year. Stakeholders recommended using plain language tables defining complex terms, grouping information, and using engaging graphics to communicate information about health insurance. Stakeholders thought that narratives of how others made decisions about insurance might be helpful to consumers, but recommended that they be tailored to the needs of specific consumers. Conclusion Strategies that clarify health insurance terms using plain language and graphics, acknowledge concern associated with making the wrong choice, calculate and enable cost comparison, and tailor information to consumers’ unique needs could benefit those enrolling in ACA Marketplace plans, Narratives developed should be simple and inclusive enough for diverse populations.
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Affiliation(s)
- A J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - K Furtado
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - K A Kaphingst
- Department of Communication, Huntsman Cancer Institute, University of Utah, 255 S Central Campus Dr., Room 2400, Salt Lake City, UT 84112, USA
| | - C Kebodeaux
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - T McBride
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130-4899, USA
| | - B Cusanno
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA
| | - M C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, 660 S. Euclid Ave, Campus Box 8100, St. Louis, MO, 63110, USA.
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92
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Why Uninsured Free Clinic Patients Don't Apply for Affordable Care Act Health Insurance in a Non-expanding Medicaid State. J Community Health 2016; 41:119-26. [PMID: 26275880 DOI: 10.1007/s10900-015-0076-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Even after the introduction of the Patient Protection and Affordable Care Act (ACA), uninsured visits remain high, especially in states that opted out of Medicaid expansion. Since the ACA does not provide universal coverage, free clinics serve as safety nets for the un- or under-insured, and will likely continue serving underserved populations. The purpose of this study is to examine factors influencing intentions to not apply for health insurance via the ACA among uninsured free clinic patients in a state not expanding Medicaid. Uninsured primary care patients utilizing a free clinic (N = 551) completed a self-administered survey in May and June 2015. Difficulty obtaining information, lack of instruction to apply, and cost, are major factors influencing intention not to apply for health insurance through the ACA. US born English speakers, non-US born English speakers, and Spanish speakers reported different kinds of perceived barriers to applying for health insurance through the ACA. Age is an important factor impacting individuals' intentions not to apply for health insurance through the ACA, as older patients in particular need assistance to obtain relevant information about the ACA and other resources. A number of unchangeable factors limit the free clinics' ability to promote enrollment of health insurance through the ACA. Yet free clinics could be able to provide some educational programs or the information of resources to patients. In particular, non-US born English speakers, Spanish speakers, and older adults need specific assistance to better understand health insurance options available to them.
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93
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Akinyemiju T, Meng Q, Vin-Raviv N. Race/ethnicity and socio-economic differences in colorectal cancer surgery outcomes: analysis of the nationwide inpatient sample. BMC Cancer 2016; 16:715. [PMID: 27595733 PMCID: PMC5011892 DOI: 10.1186/s12885-016-2738-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 08/21/2016] [Indexed: 12/17/2022] Open
Abstract
Background The purpose of this study was to examine racial and socio-economic differences in the receipt of laparoscopic or open surgery among patients with colorectal cancer, and to determine if racial and socio-economic differences exist in post-surgical complications, in-hospital mortality and hospital length of stay among patients who received surgery. Methods We conducted a cross-sectional analysis of hospitalized patients with a primary diagnosis of colorectal cancer between 2007 and 2011 using data from Nationwide Inpatient Sample. ICD-9 codes were used to capture primary diagnosis, surgical procedures, and health outcomes during hospitalization. We used logistic regression analysis to determine racial and socio-economic predictors of surgery type, post-surgical complications and mortality, and linear regression analysis to assess hospital length of stay. Results A total of 122,631 patients were admitted with a primary diagnosis of malignant colorectal cancer between 2007 and 2011. Of these, 17,327 (14.13 %) had laparoscopic surgery, 70,328 (57.35 %) received open surgery, while 34976 (28.52 %) did not receive any surgery. Black (36 %) and Hispanic (34 %) patients were more likely to receive no surgery compared with Whites (27 %) patients. However, among patients that received any surgery, there were no racial differences in which surgery was received (laparoscopic versus open, p = 0.2122), although socio-economic differences remained, with patients from lower residential income areas significantly less likely to receive laparoscopic surgery compared with patients from higher residential income areas (OR: 0.74, 95 % CI: 0.70-0.78). Among patients who received any surgery, Black patients (OR = 1.07, 95 % CI: 1.01-1.13), and patients with Medicare (OR = 1.16, 95 % CI: 1.11-1.22) and Medicaid (OR = 1.15, 95 % CI: 1.07-1.25) insurance experienced significantly higher post-surgical complications, in-hospital mortality (Black OR = 1.18, 95 % CI: 1.00-1.39), and longer hospital stay (Black β = 1.33, 95 % CI: 1.16-1.50) compared with White patients or patients with private insurance. Conclusion Racial and socio-economic differences were observed in the receipt of surgery and surgical outcomes among hospitalized patients with malignant colorectal cancer in the US.
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Affiliation(s)
- Tomi Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA. .,Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Qingrui Meng
- Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-0022, USA
| | - Neomi Vin-Raviv
- University of Northern Colorado Cancer Rehabilitation Institute, Greeley, Colorado, USA.,School of Social Work, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado, USA
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94
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Emerson ND, Morrell HER, Neece C. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity. J Autism Dev Disord 2016; 46:127-138. [PMID: 26280401 DOI: 10.1007/s10803-015-2555-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children.
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Affiliation(s)
- Natacha D Emerson
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA.
| | - Holly E R Morrell
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA
| | - Cameron Neece
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Loma Linda, CA, 92354, USA
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95
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Husaini BA, Levine RS, Norris KC, Cain V, Bazargan M, Moonis M. Heart Failure Hospitalization by Race/Ethnicity, Gender and Age in California: Implications for Prevention. Ethn Dis 2016; 26:345-54. [PMID: 27440974 PMCID: PMC4948801 DOI: 10.18865/ed.26.3.345] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE We examined variation in rates of hospitalization, risk factors, and costs by race/ethnicity, gender and age among heart failure (HF) patients. METHODS We analyzed California hospital discharge data for patients in 2007 (n=58,544) and 2010 (n=57,219) with a primary diagnosis of HF (ICD-9 codes: 402, 404, 428). HF cases included African Americans (Blacks; 14%), Hispanic/Latinos (21%), and non-Hispanic Whites (65%). Age-adjusted prevalence rates per 100,000 US population were computed per CDC methodology. RESULTS Four major trends emerged: 1) Overall HF rates declined by 7.7% from 284.7 in 2007 to 262.8 in 2010; despite the decline, the rates for males and Blacks remained higher compared with others in both years; 2) while rates for Blacks (aged ≤54) were 6 times higher compared with same age Whites, rates for Hispanics were higher than Whites in the middle age category; 3) risk factors for HF included hypertension, chronic heart disease, chronic kidney disease, atrial fibrillation, and chronic obstructive pulmonary disease; and 4) submitted hospitalization costs were higher for males, Blacks, and younger patients compared with other groups. CONCLUSIONS Health inequality in HF persists as hospitalization rates for Blacks remain higher compared with Whites and Hispanics. These findings reinforce the need to determine whether increased access to providers, or implementing proven hypertension and diabetes preventive programs among minorities might reduce subsequent hospitalization for HF in these populations.
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Affiliation(s)
- Baqar A. Husaini
- Center for Prevention Research, Tennessee State University, Nashville, TN
| | | | | | - Van Cain
- Center for Prevention Research, Tennessee State University, Nashville, TN
| | - Mohsen Bazargan
- Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Majaz Moonis
- University of Massachusetts Medical School, Worcester, MA
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96
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Peetoom KKB, Ploum LJL, Smits JJM, Halbach NSJ, Dinant GJ, Cals JWL. Childhood fever in well-child clinics: a focus group study among doctors and nurses. BMC Health Serv Res 2016; 16:240. [PMID: 27393615 PMCID: PMC4938983 DOI: 10.1186/s12913-016-1488-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022] Open
Abstract
Background Fever is common in children aged 0-4 years old and often leads to parental worries and in turn, high use of healthcare services. Educating parents may have beneficial effects on their sense of coping and fever management. Most parents receive information when their child is ill but it might be more desirable to educate parents in the setting of well-child clinics prior to their child becoming ill, in order to prepare parents for future illness management. This study aims to explore experiences of well-child clinic professionals when dealing with childhood fever and current practices of fever information provision to identify starting points for future interventions. Methods We held four focus group discussions based on naturalistic enquiry among 22 well-child clinic professionals. Data was analysed using the constant comparative technique. Results Well-child clinic professionals regularly received questions from parents about childhood fever and felt that parental worries were the major driving factor behind these contacts. These worries were assumed to be driven by: (1) lack of knowledge (2) experiences with fever (3) educational level and size social network (4) inconsistencies in paracetamol administration advice among healthcare professionals. Well-child clinic professionals perceive current information provision as limited and stated a need for improvement. For example, information should be consistent, easy to find and understand. Conclusions Fever-related questions are common in well-child care and professionals perceive that most of the workload is driven by parental worries. The focus group discussions revealed a desire to optimise the current limited information provision for childhood fever. Future interventions aimed at improving information provision for fever in well-child clinics should consider parental level of knowledge, experience, educational level and social network and inconsistencies among healthcare providers. Future fever information provision should focus on improving fever management and practical skills. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1488-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kirsten K B Peetoom
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Luc J L Ploum
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jacqueline J M Smits
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Nicky S J Halbach
- Envida homecare organisation, PO Box 241, 6200, AE, Maastricht, The Netherlands
| | - Geert-Jan Dinant
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
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Racial disparities in individual breast cancer outcomes by hormone-receptor subtype, area-level socio-economic status and healthcare resources. Breast Cancer Res Treat 2016; 157:575-86. [PMID: 27255533 DOI: 10.1007/s10549-016-3840-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/21/2016] [Indexed: 01/22/2023]
Abstract
The aim of the study is to determine the influence of area-level socio-economic status and healthcare access in addition to tumor hormone-receptor subtype on individual breast cancer stage, treatment, and mortality among Non-Hispanic (NH)-Black, NH-White, and Hispanic US adults. Analysis was based on 456,217 breast cancer patients in the SEER database from 2000 to 2010. Multilevel and multivariable-adjusted logistic and Cox proportional hazards regression analysis was conducted to account for clustering by SEER registry of diagnosis. NH-Black women had greater area-level access to healthcare resources compared with women of other races. For instance, the average numbers of oncology hospitals per million population in counties with NH-Black, NH-White, and Hispanic women were 8.1, 7.7, and 5.0 respectively; average numbers of medical doctors per million in counties with NH-Black, NH-White, and Hispanic women were 100.7, 854.0, and 866.3 respectively; and average number of Ob/Gyn in counties with NH-Black, NH-White, and Hispanic women was 155.6, 127.4, and 127.3, respectively (all p values <0.001). Regardless, NH-Black women (HR 1.39, 95 % CI 1.36-1.43) and Hispanic women (HR 1.05, 95 % CI 1.03-1.08) had significantly higher breast cancer mortality compared with NH-White women even after adjusting for hormone-receptor subtype, area-level socio-economic status, and area-level healthcare access. In addition, lower county-level socio-economic status and healthcare access measures were significantly and independently associated with stage at presentation, surgery, and radiation treatment as well as mortality after adjusting for age, race/ethnicity, and HR subtype. Although breast cancer HR subtype is a strong, important, and consistent predictor of breast cancer outcomes, we still observed significant and independent influences of area-level SES and HCA on breast cancer outcomes that deserve further study and may be critical to eliminating breast cancer outcome disparities.
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98
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Sinclair LB, Taft KE, Sloan ML, Stevens AC, Krahn GL. Tools for improving clinical preventive services receipt among women with disabilities of childbearing ages and beyond. Matern Child Health J 2016; 19:1189-201. [PMID: 25359095 DOI: 10.1007/s10995-014-1627-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Efforts to improve clinical preventive services (CPS) receipt among women with disabilities are poorly understood and not widely disseminated. The reported results represent a 2-year, Centers for Disease Control and Prevention and Association of Maternal and Child Health Programs partnership to develop a central resource for existing tools that are of potential use to maternal and child health practitioners who work with women with disabilities. Steps included contacting experts in the fields of disability and women's health, searching the Internet to locate examples of existing tools that may facilitate CPS receipt, convening key stakeholders from state and community-based programs to determine their potential use of the tools, and developing an online Toolbox. Nine examples of existing tools were located. The tools focused on facilitating use of the CPS guidelines, monitoring CPS receipt among women with disabilities, improving the accessibility of communities and local transportation, and training clinicians and women with disabilities. Stakeholders affirmed the relevance of these tools to their work and encouraged developing a Toolbox. The Toolbox, launched in May 2013, provides information and links to existing tools and accepts feedback and proposals for additional tools. This Toolbox offers central access to existing tools. Maternal and child health stakeholders and other service providers can better locate, adopt and implement existing tools to facilitate CPS receipt among adolescent girls with disabilities who are transitioning into adult care as well as women with disabilities of childbearing ages and beyond.
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Affiliation(s)
- Lisa B Sinclair
- Disability and Health Branch, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 1600 Clifton Rd, E-88, Atlanta, GA, 30333, USA,
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Hatch B, Bailey SR, Cowburn S, Marino M, Angier H, DeVoe JE. Community Health Center Utilization Following the 2008 Medicaid Expansion in Oregon: Implications for the Affordable Care Act. Am J Public Health 2016; 106:645-50. [PMID: 26890164 DOI: 10.2105/ajph.2016.303060] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess longitudinal patterns of community health center (CHC) utilization and the effect of insurance discontinuity after Oregon's 2008 Medicaid expansion (the Oregon Experiment). METHODS We conducted a retrospective cohort study with electronic health records and Medicaid data. We divided individuals who gained Medicaid in the Oregon Experiment into those who maintained (n = 788) or lost (n = 944) insurance coverage. We compared these groups with continuously insured (n = 921) and continuously uninsured (n = 5416) reference groups for community health center utilization rates over a 36-month period. RESULTS Both newly insured groups increased utilization in the first 6 months. After 6 months, use among those who maintained coverage stabilized at a level consistent with the continuously insured, whereas it returned to baseline for those who lost coverage. CONCLUSIONS Individuals who maintained coverage through Oregon's Medicaid expansion increased long-term utilization of CHCs, whereas those with unstable coverage did not. POLICY IMPLICATIONS This study predicts long-term increase in CHC utilization following Affordable Care Act Medicaid expansion and emphasizes the need for policies that support insurance retention.
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Affiliation(s)
- Brigit Hatch
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
| | - Steffani R Bailey
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
| | - Stuart Cowburn
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
| | - Miguel Marino
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
| | - Heather Angier
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
| | - Jennifer E DeVoe
- Brigit Hatch, Steffani R. Bailey, Miguel Marino, Heather Angier, and Jennifer E. DeVoe are with Oregon Health and Science University, Portland. Stuart Cowburn and Jennifer E. DeVoe are with OCHIN, Portland
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100
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Hatch B, Tillotson C, Angier H, Marino M, Hoopes M, Huguet N, DeVoe J. Using the electronic health record for assessment of health insurance in community health centers. J Am Med Inform Assoc 2016; 23:984-90. [PMID: 26911812 DOI: 10.1093/jamia/ocv179] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/26/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To demonstrate use of the electronic health record (EHR) for health insurance surveillance and identify factors associated with lack of coverage. MATERIALS AND METHODS Using EHR data, we conducted a retrospective, longitudinal cohort study of adult patients (n = 279 654) within a national network of community health centers during a 2-year period (2012-2013). RESULTS Factors associated with higher odds of being uninsured (vs Medicaid-insured) included: male gender, age >25 years, Hispanic ethnicity, income above the federal poverty level, and rural residence (P < .01 for all). Among patients with no insurance at their initial visit (n = 114 000), 50% remained uninsured for every subsequent visit. DISCUSSION During the 2 years prior to 2014, many patients utilizing community health centers were unable to maintain stable health insurance coverage. CONCLUSION As patients gain access to health insurance under the Affordable Care Act, the EHR provides a novel approach to help track coverage and support vulnerable patients in gaining and maintaining coverage.
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Affiliation(s)
- Brigit Hatch
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA
| | - Carrie Tillotson
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA
| | - Heather Angier
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA
| | - Miguel Marino
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA
| | - Megan Hoopes
- OCHIN, Inc, Research Division, Portland, Oregon, USA
| | - Nathalie Huguet
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA
| | - Jennifer DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland Oregon, USA OCHIN, Inc, Research Division, Portland, Oregon, USA
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