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Schwarz T, Schmidt AE, Bobek J, Ladurner J. Barriers to accessing health care for people with chronic conditions: a qualitative interview study. BMC Health Serv Res 2022; 22:1037. [PMID: 35964086 PMCID: PMC9375930 DOI: 10.1186/s12913-022-08426-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/05/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria's fragmented social health insurance system. METHODS Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque's model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness. RESULTS The findings from the 25 expert interviews were organised within Levesque's conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients' ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient's socio-economic status, health literacy and ability to pay. CONCLUSIONS While studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential 'invisible' barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients' specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.
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Affiliation(s)
- Tanja Schwarz
- Austrian National Public Health Institute, Addiction Competence Centre, Stubenring 6, 1010, Vienna, Austria
| | - Andrea E Schmidt
- Austrian National Public Health Institute, Competence Centre on Climate and Health, Stubenring 6, 1010, Vienna, Austria.
| | - Julia Bobek
- Austrian National Public Health Institute, Health Economics and Health Systems Analysis, Stubenring 6, 1010, Vienna, Austria
| | - Joy Ladurner
- Austrian National Public Health Institute, Psychosocial Health, Stubenring 6, 1010, Vienna, Austria
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Zhang B, Li ZF, An ZY, Zhang L, Wang JY, Hao MD, Jin YJ, Li D, Song AJ, Ren Q, Chen WB. Association Between Asthma and All-Cause Mortality and Cardiovascular Disease Morbidity and Mortality: A Meta-Analysis of Cohort Studies. Front Cardiovasc Med 2022; 9:861798. [PMID: 35369308 PMCID: PMC8968068 DOI: 10.3389/fcvm.2022.861798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAsthma and cardiovascular disease (CVD) share many risk factors. Previous meta-analyses indicated that asthma is associated with an increased risk of CVD and all-cause mortality, but these studies were limited by unstandardized search strategies and the number of articles included.ObjectiveWe sought to systematically synthesize evidence investigating the impact of asthma on all-cause mortality and CVD morbidity and mortality.MethodsWe searched in PubMed and EMBASE for observational cohort studies (inception dates to November 10, 2021) that had both asthma groups and control groups. We also manually searched the reference lists of correlative articles to include other eligible studies. Data for associations between asthma and all-cause mortality and CVD morbidity and mortality were needed.ResultsWe summarized the findings from 30 cohort studies comprising 4,157,823 participants. Asthma patients had increased CVD morbidity [relative risk (RR) = 1.28, 95% confidence interval (CI) = 1.16–1.40] and increased CVD mortality (RR = 1.25, 95% CI = 1.14–1.38). Asthma patients also had increased risk of all-cause mortality (RR = 1.38, 95% CI = 1.07–1.77). In subgroup analyses, female asthma patients had a higher risk of CVD morbidity and all-cause mortality than male asthma patients, and late-onset asthma patients had a higher risk of CVD morbidity than early-onset asthma patients.ConclusionAsthma patients have increased risk of all-cause mortality and CVD morbidity and mortality. This information reminds clinicians to be aware of the risk of CVD and all-cause mortality in asthma patients.Systematic Review Registrationhttp://www.crd.york.ac.uk/PROSPERO/, PROSPERO, identifier: CRD 42021290082.
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Affiliation(s)
- Bin Zhang
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Zhi-Fei Li
- Aerospace Center Hospital, Beijing, China
| | - Zhuo-Yu An
- Peking University People's Hospital, Beijing, China
| | - Li Zhang
- Aerospace Center Hospital, Beijing, China
| | | | | | - Yi-Jing Jin
- Peking University First Hospital, Beijing, China
| | - Dong Li
- Department of Intensive Care Unit and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - An-Jian Song
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Qiang Ren
- Department of Cardiovascular Disease and Clinical Experimental Center, Jiangmen Central Hospital, Jiangmen, China
| | - Wen-Biao Chen
- Department of Respiratory Medicine, People's Hospital of Longhua, The Affiliated Hospital of Southern Medical University, Shenzhen, China
- *Correspondence: Wen-Biao Chen
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Hagemann E, Silva DT, Davis JA, Gibson LY, Prescott SL. Developmental Origins of Health and Disease (DOHaD): The importance of life-course and transgenerational approaches. Paediatr Respir Rev 2021; 40:3-9. [PMID: 34148804 DOI: 10.1016/j.prrv.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
With well-established evidence that early life conditions have a profound influence on lifespan and health-span, new interventional birth cohorts are examining ways to optimise health potential of individuals and communities. These are aimed at going beyond preventing disease, to the conditions that facilitate flourishing from an early age. Covering diverse domains, local community projects, such as The ORIGINS Project, are taking a broader approach to the protective and buffering factors that enhance resilience and reduce allostatic load, such as building nature relatedness, interpersonal relationships, mindfulness, and positive emotions. Such cohorts aim to address how 'upstream' approaches will have flow on effects to the 'historical' risk targets (such as poor nutrition, physical inactivity, and stress) by influencing these core behaviours through better relationships with self, community, and the environment. In addition to scientific pursuit, interventional cohorts can contribute to solutions ineverycommunity - nourishing individuals and communities towards positive change.
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Affiliation(s)
- Erika Hagemann
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, PO Box 855, West Perth, WA 6872, Australia; Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia.
| | - Desiree T Silva
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, PO Box 855, West Perth, WA 6872, Australia; The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia; Joondalup Health Campus, Suite 210 Specialist Centre, 60 Shenton Avenue, Joondalup WA 6027, Australia; Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Jacqueline A Davis
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, PO Box 855, West Perth, WA 6872, Australia; The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia
| | - Lisa Y Gibson
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, PO Box 855, West Perth, WA 6872, Australia; The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia; Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Susan L Prescott
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands WA 6009, PO Box 855, West Perth, WA 6872, Australia; The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia; Joondalup Health Campus, Suite 210 Specialist Centre, 60 Shenton Avenue, Joondalup WA 6027, Australia; Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia; inVIVO Planetary Health of the Worldwide Universities Network (WUN), West New York, NJ, United States
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Ng CACM, Knuiman MW, Murray K, Divitini ML, Musk AWB, James AL. Childhood asthma and cardiovascular morbidity and mortality in adulthood: The Busselton Health Study. Pediatr Pulmonol 2021; 56:1915-1923. [PMID: 33819390 DOI: 10.1002/ppul.25386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-term childhood asthma studies that investigate adult outcomes other than respiratory morbidity are lacking. This study examines the associations of childhood asthma and the occurrence of cardiovascular disease (CVD) events and mortality in adulthood. METHODS A cohort of 4430 school children (aged 17 years) who attended the Busselton Health Study between 1967 and 1983 were analyzed. Self-reported history of doctor-diagnosed asthma was determined based on the questionnaire. Subsequent CVD events (hospital admissions or death) up to 2014 were identified using the Western Australia Data Linkage System. Cox regression models were used to investigate the impact of childhood asthma on CVD events and mortality in adulthood. A subgroup of 2153 participants who re-attended a survey in young adulthood was also analyzed. RESULTS A total of 462 (10%) of the cohort had childhood asthma. During follow-up, 867 participants experienced a CVD event and 22 participants died from CVD. Childhood asthma was not associated with the risk of CVD events in adulthood (HR, 1.12; 95% CI: 0.91-1.39; p = .2833) and this persisted after adjustment for confounders. Childhood asthma was not associated with coronary heart disease events (HR, 0.72; 95% CI: 0.40-1.30; p = .2761), heart failure events (HR, 0.55; 95% CI: 0.07-4.13; p = .5604) or CVD mortality (HR, 0.91; 95% CI: 0.21-3.89; p = .8987) in adulthood. CONCLUSION Childhood asthma is not associated with the risk of CVD events and mortality in adulthood.
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Affiliation(s)
- Christopher A C M Ng
- Medical School, The University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
| | - Matthew W Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Mark L Divitini
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Arthur W Bill Musk
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Alan L James
- Medical School, The University of Western Australia, Perth, Australia.,Sir Charles Gairdner Hospital, Perth, Australia
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