1
|
Sturmberg JP, Martin JH, Tramonti F, Kühlein T. The need for a change in medical research thinking. Eco-systemic research frames are better suited to explore patterned disease behaviors. Front Med (Lausanne) 2024; 11:1377356. [PMID: 38887671 PMCID: PMC11180740 DOI: 10.3389/fmed.2024.1377356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
Many practicing physicians struggle to properly evaluate clinical research studies - they either simply do not know them, regard the reported findings as 'truth' since they were reported in a 'reputable' journal and blindly implement these interventions, or they disregard them as having little pragmatic impact or relevance to their daily clinical work. Three aspects for the latter are highlighted: study populations rarely reflect their practice population, the absolute average benefits on specific outcomes in most controlled studies, while statistically significant, are so small that they are pragmatically irrelevant, and overall mortality between the intervention and control groups are unaffected. These observations underscore the need to rethink our research approaches in the clinical context - moving from the predominant reductionist to an eco-systemic research approach will lead to knowledge better suited to clinical decision-making for an individual patient as it takes into account the complex interplay of multi-level variables that impact health outcomes in the real-world setting.
Collapse
Affiliation(s)
- Joachim P. Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- International Society for Systems and Complexity Sciences for Health, Waitsfield, VT, United States
| | - Jennifer H. Martin
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
| | - Francesco Tramonti
- Department of Mental Health, Azienda USL Toscana Nordovest & Istituto di Psicoterapia Relazionale, Pisa, Italy
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
2
|
Tsai MM, Yeb JA, Jackson KE, Gosliner W, Fernald LC, Hamad R. Understanding Multiprogram Take-Up of Safety Net Programs Among California Families. AJPM FOCUS 2024; 3:100216. [PMID: 38638939 PMCID: PMC11024909 DOI: 10.1016/j.focus.2024.100216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Introduction The U.S. safety net, which provides critical aid to households with low income, is composed of a patchwork of separate programs, and many people with low income benefit from accessing <1 program. However, little is known about multiprogram take-up, that is, participation conditioned on eligibility. This study examined individual and multiprogram take-up patterns and sociodemographic factors associated with multiprogram take-up of U.S. safety net programs. Methods The Assessing California Communities' Experiences with Safety Net Supports study interviewed Californians and reviewed their 2019 tax forms between August 2020 and May 2021. Take-up of safety net programs was calculated among eligible participants (n=365), including the Earned Income Tax Credit; Supplemental Nutrition Assistance Program; the Special Supplemental Nutrition Program for Women, Infants, and Children; and Medicaid. Multivariable regressions identified sociodemographic factors associated with take-up of multiple programs. Results Take-up was highest for Medicaid (90.6%) and lowest for Supplemental Nutrition Assistance Program (57.5%). Among people who received benefits from at least 1 other program, take-up ranged from 81.7% to 84.8% for the Earned Income Tax Credit; 54.4%-62.0% for Supplemental Nutrition Assistance Program; 74.3%-80.1% for Special Supplemental Nutrition Program for Women, Infants, and Children; and 89.7%-98.1% for Medicaid. Having a lower income and being younger were associated with concurrent take-up of Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children. Among Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children recipients, having higher income, being older, and being primarily English speaking were associated with Earned Income Tax Credit take-up. Conclusions Individual and multiprogram take-up vary between programs and by sociodemographic factors. Findings suggest opportunities to increase take-up of potentially synergistic programs by improving cross-program coordination, data sharing, and targeted recruitment of underenrolled subgroups (Supplemental Nutrition Assistance Program and Special Supplemental Nutrition Program for Women, Infants, and Children).
Collapse
Affiliation(s)
- Marisa M. Tsai
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Joseph A. Yeb
- Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts
| | - Kaitlyn E. Jackson
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Wendi Gosliner
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Lia C.H. Fernald
- Community Health Sciences Division, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Rita Hamad
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| |
Collapse
|
3
|
MCCONNELL MARGARET, AGARWAL SUMIT, HANSON ERIKA, MCCRADY ERIN, PARKER MARGARETG, BONA KIRA. Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings. Milbank Q 2024; 102:64-82. [PMID: 37994263 PMCID: PMC10938935 DOI: 10.1111/1468-0009.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
Policy Points Pregnancy and childhood are periods of heightened economic vulnerability, but current policies for addressing health-related social needs, including screening and referral programs, may be insufficient because of persistent gaps, incomplete follow-up, administrative burden, and limited take-up. To bridge gaps in the social safety net, direct provision of cash transfers to low-income families experiencing health challenges during pregnancy, infancy, and early childhood could provide families with the flexibility and support to enable caregiving, increase access to health care, and improve health outcomes.
Collapse
Affiliation(s)
| | | | - ERIKA HANSON
- Center for Health Law and Policy Innovation, Harvard Law School
| | - ERIN MCCRADY
- Center for Health Law and Policy Innovation, Harvard Law School
| | - MARGARET G. PARKER
- Child Health Equity CenterUniversity of Massachusetts Chan Medical School
| | - KIRA BONA
- Harvard Medical School
- Dana‐Farber Cancer Institute
- Boston Children's Hospital
| |
Collapse
|
4
|
Burgess-Flowers J, de Saxe Zerden L, Yokovich K. The social determinants of health, social work, and dental patients: a case study. SOCIAL WORK IN HEALTH CARE 2024; 63:117-130. [PMID: 38111138 DOI: 10.1080/00981389.2023.2292546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/16/2023] [Indexed: 12/20/2023]
Abstract
Oral health has been largely overlooked in conceptualizing health, and the workforce responsible for addressing the Social Determinants of Health (SDOH) within oral health settings has received little attention. While the role for social work in oral health has remained limited, there has been recent growth articulating its role in dental education. This paper presents a case study of how social work has been implemented into one school of dentistry in the U.S. to address SDOH and offers a roadmap for integration of social work into dental education, including opportunities for interprofessional health care experiences related to SDOH.
Collapse
Affiliation(s)
- Jamie Burgess-Flowers
- Workman School of Dental Medicine, High Point University, High Point, North Carolina, USA
| | - Lisa de Saxe Zerden
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kelsey Yokovich
- Foundation for Health Leadership and Innovation, Cary, North Carolina, USA
| |
Collapse
|
5
|
Giannouchos TV, Li Z, Hung P, Li X, Olatosi B. Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022. J Community Health 2023; 48:824-833. [PMID: 37133745 PMCID: PMC10154180 DOI: 10.1007/s10900-023-01216-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2023] [Indexed: 05/04/2023]
Abstract
Although rural communities have been hard-hit by the COVID-19 pandemic, there is limited evidence on COVID-19 outcomes in rural America using up-to-date data. This study aimed to estimate the associations between hospital admissions and mortality and rurality among COVID-19 positive patients who sought hospital care in South Carolina. We used all-payer hospital claims, COVID-19 testing, and vaccination history data from January 2021 to January 2022 in South Carolina. We included 75,545 hospital encounters within 14 days after positive and confirmatory COVID-19 testing. Associations between hospital admissions and mortality and rurality were estimated using multivariable logistic regressions. About 42% of all encounters resulted in an inpatient hospital admission, while hospital-level mortality was 6.3%. Rural residents accounted for 31.0% of all encounters for COVID-19. After controlling for patient-level, hospital, and regional characteristics, rural residents had higher odds of overall hospital mortality (Adjusted Odds Ratio - AOR = 1.19, 95% Confidence Intervals - CI = 1.04-1.37), both as inpatients (AOR = 1.18, 95% CI = 1.05-1.34) and as outpatients (AOR = 1.63, 95% CI = 1.03-2.59). Sensitivity analyses using encounters with COVID-like illness as the primary diagnosis only and encounters from September 2021 and beyond - a period when the Delta variant was dominant and booster vaccination was available - yielded similar estimates. No significant differences were observed in inpatient hospitalizations (AOR = 1.00, 95% CI = 0.75-1.33) between rural and urban residents. Policymakers should consider community-based public health approaches to mitigate geographic disparities in health outcomes among disadvantaged population subgroups.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA.
- Big Data Health Science Center, University of South Carolina, Columbia, SC, USA.
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Zhenlong Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, USA
- Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, USA
| | - Peiyin Hung
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA
- Big Data Health Science Center, University of South Carolina, Columbia, SC, USA
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoming Li
- Big Data Health Science Center, University of South Carolina, Columbia, SC, USA
- Department of Health Promotion Education and Behavior, University of South Carolina, Columbia, SC, USA
| | - Bankole Olatosi
- Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Columbia, SC, 29208, USA
- Big Data Health Science Center, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
6
|
Mulia N, Ye Y, Greenfield TK, Martinez P, Patterson D, Kerr WC, Karriker-Jaffe KJ. Inequitable access to general and behavioral healthcare in the US during the COVID-19 pandemic: A role for telehealth? Prev Med 2023; 169:107426. [PMID: 36709864 PMCID: PMC9877144 DOI: 10.1016/j.ypmed.2023.107426] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023]
Abstract
Wide-ranging effects of the COVID-19 pandemic have led to increased psychological distress and alcohol consumption, and disproportionate hardship for disadvantaged groups. Early in the pandemic, telehealth services were expanded to maintain healthcare access amidst lockdowns, medical office closures, and fear of infection. This study examines general and behavioral healthcare access and disparities during the first year of the pandemic. Data are from the 2019-2020 US National Alcohol Survey (collected February 2019 to April 2020) and its COVID follow-up survey conducted January 30 to March 28, 2021 (N = 1819). General and behavioral healthcare-related outcomes were assessed at follow-up, and included perceived need for and receipt of care, delayed care, and use of telehealth since April 1, 2020. Results indicate that the majority of respondents with perceived need for healthcare received some behavioral healthcare (reported by 63%) and particularly general healthcare (88%), but nearly half (48%) delayed needed care. Delays were mostly due to COVID-related reasons, but cost barriers also were common and significantly impeded care-seeking by uninsured persons, young adults, rural residents, and persons whose employment was reduced by the pandemic. Disparities in the receipt of healthcare were pronounced for Hispanic/Latinx (vs. White) and lower-income (vs. higher-income) groups (AORs <0.37, p's < 0.05). Notably, telehealth was commonly used by Hispanic/Latinx and lower-income groups for general and particularly behavioral healthcare. Results suggest that telehealth has provided an important bridge to healthcare for certain medically underserved groups during the pandemic, and may be vital to future efforts to increase equity in healthcare access.
Collapse
Affiliation(s)
- Nina Mulia
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Yu Ye
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Priscilla Martinez
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Deidre Patterson
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | | |
Collapse
|
7
|
Brown H, Xiang H, Cheetham M, Morris S, Gibson M, Katikireddi SV, Munford LA, Taylor-Robinson D, Finney H, Bartle V, Baxter AJ, Wickham S, Craig P, Bambra C. Exploring the health and sociodemographic characteristics of people seeking advice with claiming universal credit: a cross-sectional analysis of UK citizens advice data, 2017-2021. BMC Public Health 2023; 23:595. [PMID: 36997889 PMCID: PMC10060933 DOI: 10.1186/s12889-023-15483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The UK Department for Work and Pensions (DWP) administers Universal Credit (UC) - the main UK benefit for people in- and out-of-work. UC is being rolled out nationally from 2013 to 2024. Citizens Advice (CA) is an independent charity that provides advice and support to people making a claim for UC. The aim of this study is to understand who is seeking advice from CA when making a UC claim and how the types of people seeking advice are changing as the rollout of UC continues. METHODS Co-developed with Citizens Advice Newcastle and Citizens Advice Northumberland we performed longitudinal analysis of national data from Citizens Advice for England and Wales on the health (mental health and limiting long term conditions) and socio-demographic of 1,003,411 observations for people seeking advice with claiming UC over four financial years (2017/18 to 2020/21). We summarised population characteristics and estimated the differences between the four financial years using population-weighted t-tests. Findings were discussed with three people with lived experience of seeking advice to claim UC to help frame our interpretation and policy recommendations. RESULTS When comparing 2017/18 to 2018/19, there was a significantly higher proportion of people with limiting long term conditions seeking advice with claiming UC than those without (+ 2.40%, 95%CI: 1.31-3.50%). However, as the rollout continued between 2018/29 and 2019/20 (-6.75%, 95%CI: -9.62%--3.88%) and between 2019/20 and 2020/21 (-2.09%, 95%CI: -2.54%--1.64%), there were significantly higher proportions of those without a limiting long term condition seeking advice than with. When comparing 2018/19 to 2019/20 and 2019/20 to 2020/21, there was a significant increase in the proportion of self-employed compared to unemployed people seeking advice with claiming UC (5.64%, 95%CI: 3.79-7.49%) and (2.26%, 95%CI: 1.29-3.23%) respectively. CONCLUSION As the rollout for UC continues, it is important to understand how changes in eligibility for UC may impact on those who need help with applying for UC. Ensuring that the advice process and application process is responsive to a range of people with different needs can help to reduce the likelihood that the process of claiming UC will exacerbate health inequalities.
Collapse
Affiliation(s)
- Heather Brown
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Huasheng Xiang
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Mandy Cheetham
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | - Steph Morris
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Marcia Gibson
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Luke Aaron Munford
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, UK
| | - David Taylor-Robinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | | | - Victoria Bartle
- Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Andrew J Baxter
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Peter Craig
- MRC/CO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| |
Collapse
|
8
|
Cooper R. Black:White Health Inequalities, Genes Versus Environment-A New Chapter? Ethn Dis 2023; 33:51-54. [PMID: 38846266 PMCID: PMC11152154 DOI: 10.18865/1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Affiliation(s)
- Richard Cooper
- Professor Emeritus, Public Health Sciences, Loyola University Chicago, Chicago, IL
| |
Collapse
|
9
|
Galea S. Principles to Guide the US Toward Better Health for All. JAMA HEALTH FORUM 2022; 3:e225359. [PMID: 36520463 DOI: 10.1001/jamahealthforum.2022.5359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
This JAMA Forum discusses ways to work toward health equity in the US, suggests structural changes that could be implemented to remedy historical underinvestments in health, and provides ideas for how to gain public trust and buy-in for policies to achieve these goals.
Collapse
Affiliation(s)
- Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts
| |
Collapse
|