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Wang Y, Jiang N, Shao H, Wang Z. Exploring unmet healthcare needs and associated inequalities among middle-aged and older adults in Eastern China during the progression toward universal health coverage. HEALTH ECONOMICS REVIEW 2024; 14:46. [PMID: 38935169 PMCID: PMC11212176 DOI: 10.1186/s13561-024-00521-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its inequalities, but little attention has been paid to the inequality in unmet healthcare needs. This study aimed to analyze the inequalities in unmet the healthcare needs of middle-aged and older adults in eastern China during the progression toward UHC. METHODS Data were obtained from the fourth, fifth, and sixth National Health Service Survey (NHSS) of Jiangsu Province, located in eastern China, during the years 2008, 2013, and 2018, respectively. Logistic regression models were used to assess the associated factors of unmet healthcare needs. The inequality was measured according to the concentration index (CI) and its decomposition. RESULTS In this study, we found that 12.86%, 2.22%, and 48.89% of middle-aged and older adults reported unmet needs for outpatient and inpatient services and physical examinations, respectively. The prevalence of unmet outpatient needs increased from 2008 to 2018, while the prevalence of unmet inpatient services was lower but maintained. The prevalence of unmet needs for physical examinations among middle-aged and older adults markedly decreased since 2008. Rural areas had a higher prevalence of unmet needs for inpatient services and physical examinations than urban areas. Unmet healthcare needs were more prevalent among the poor. The pro-poor inequalities of unmet healthcare needs have been mitigated during the progression toward UHC; however, they remain predominant among rural middle-aged and older adults for outpatient and inpatient services. Socioeconomic factors significantly influenced unmet healthcare needs and contributed to their inequalities. CONCLUSIONS The findings characterize the prevalence and inequality of unmet healthcare need among middle-aged and older adults in eastern China during the progression toward UHC. Policy interventions should be actively advocated to effectively mitigate the unmet healthcare needs and address the associated inequalities.
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Affiliation(s)
- Yunhan Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Nan Jiang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China
| | - Haiya Shao
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, 211166, China.
- The Public Health Policy and Management Innovation Research Team, Nanjing Medical University, Nanjing, 211166, China.
- School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
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DeSouza A, Wang D, Wong JJ, Furlan AD, Hogg-Johnson S, Macedo L, Mior S, Côté P. Prevalence of Unmet Rehabilitation Needs Among Canadians Living With Long-term Conditions or Disabilities During the First Wave of the COVID-19 Pandemic. Arch Phys Med Rehabil 2024; 105:268-279. [PMID: 37541355 DOI: 10.1016/j.apmr.2023.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE We aimed to describe the prevalence of unmet rehabilitation needs among a sample of Canadians living with long-term conditions or disabilities during the first wave of the COVID-19 pandemic. DESIGN Cross-sectional survey. SETTING Individuals residing in Canada during the first wave of the COVID-19 pandemic. PARTICIPANTS Eligible participants were Canadians living with long-term conditions or disabilities, 15 years or older living in 1 of the 10 provinces or 3 territories (n=13,487). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE We defined unmet rehabilitation needs as those who reported needing rehabilitation (ie, physiotherapy/massage therapy/chiropractic, speech, or occupational therapy, counseling services, support groups) but did not receive it because of the COVID-19 pandemic. We calculated the national, age, gender, and province/territory-specific prevalence and 95% confidence interval of unmet rehabilitation needs. RESULTS During the first wave of the pandemic, the prevalence of unmet rehabilitation needs among Canadians with long-term conditions or disabilities was 49.3% (95% confidence interval [CI]; 48.3, 50.3]). The age-specific prevalence was higher among individuals 15-49 years old (55.6%; 95% CI [54.2, 57.1]) than those 50 years and older (46.0%; 95% CI [44.5, 47.4]). Females (53.7%; 95% CI [52.6, 54.9]) had higher unmet needs than males (44.1%; 95% CI [42.3, 45.9]). Unmet rehabilitation needs varied across provinces and territories. CONCLUSIONS In this sample, almost 50% of Canadians living with long-term conditions or disabilities had unmet rehabilitation needs during the first wave of the COVID-19 pandemic. This suggests that a significant gap between the needs for and delivery of rehabilitation care existed during the early phase of the pandemic.
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Affiliation(s)
- Astrid DeSouza
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Dan Wang
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Jessica J Wong
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada
| | - Andrea D Furlan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Sheilah Hogg-Johnson
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada; Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Silvano Mior
- Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada; Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Pierre Côté
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada; Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Ontario, Canada.
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Okamoto S, Sata M, Rosenberg M, Nakagoshi N, Kamimura K, Komamura K, Kobayashi E, Sano J, Hirazawa Y, Okamura T, Iso H. Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare. HEALTH ECONOMICS REVIEW 2024; 14:8. [PMID: 38289516 PMCID: PMC10826197 DOI: 10.1186/s13561-023-00475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). METHODS Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. RESULTS Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. CONCLUSIONS Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.
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Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan.
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan.
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan.
| | - Mizuki Sata
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Campus USÖ, Örebro, SE-701 82, Sweden
| | - Megumi Rosenberg
- World Health Organization Centre for Health Development, I.H.D. Centre Building, 9th Floor 7. 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe City, Hyogo, Japan
| | - Natsuko Nakagoshi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Kazuki Kamimura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Hirao School of Management, Konan University, 8-33 Takamatsucho, Nishinomiya City, Hyogo, Japan
| | - Kohei Komamura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Erika Kobayashi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan
| | - Junko Sano
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Tokyo Kasei Gakuin University, 22 Sanbancho, Chiyoda City, Tokyo, Japan
| | - Yuzuki Hirazawa
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
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Hoven H, Backhaus I, Gerő K, Kawachi I. Characteristics of employment history and self-perceived barriers to healthcare access. Eur J Public Health 2023; 33:1080-1087. [PMID: 37857366 PMCID: PMC10710348 DOI: 10.1093/eurpub/ckad178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators. METHODS We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics. RESULTS Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators. CONCLUSION Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.
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Affiliation(s)
- Hanno Hoven
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Insa Backhaus
- Department of Sociology and Political Science, Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Krisztina Gerő
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Ichiro Kawachi
- Department of Social & Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
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Bajgain BB, Chowdhury MZI, Dahal R, Bajgain KT, Adhikari K, Chowdhury N, Turin TC. Unmet Primary Health Care Needs among Nepalese Immigrant Population in Canada. Healthcare (Basel) 2023; 11:2120. [PMID: 37570361 PMCID: PMC10419120 DOI: 10.3390/healthcare11152120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Immigrants represent over one-fifth (21.9%) of the Canadian population, which is an increasing trend. Primary care is a gateway to accessing the healthcare system for the majority of Canadians seeking medical services; however, Canada reported a growing shortage of healthcare providers, mainly primary care practitioners. Canadians, including immigrants, encounter many unmet healthcare needs due to various reasons. This study aimed to assess unmet healthcare (UHC) needs and associated factors among Nepalese immigrants residing in Calgary. METHODS A cross-sectional study using a self-administered questionnaire was conducted in 2019. UHC needs were measured based on a single-item question: "During the past 12 months, was there ever a time that you felt you needed medical help, but you did not receive it". A follow-up question was asked to learn about associated unmet needs factors, and the responses were categorized into availability, accessibility, and acceptability. Descriptive and multivariable logistic regression was employed to assess the association between UHC needs and its predictors by using STATA version 14.2. RESULTS Of 401 study participants, nearly half of the participants (n = 187; 46.63%) reported UHC needs, which was not significantly different among male and female participants (p = 0.718). UHC needs were nearly two times higher among those aged 26-45 (AOR 1.93) and those ≥56 years (AOR 2.17) compared to those under 25 years of age. The top reasons reported for unmet needs were long waits to access care (67.91%), healthcare costs (57.22%), and lack of knowing where to get help (31.55%). Overall, "services availability when required" was a leading obstacle that accounted for UHC needs (n = 137, 73.26%). Nearly two-thirds (n = 121, 64.71%) of participants reported that "accessibility of services" was a barrier, followed by "acceptability (n = 107, 57.22%). Those who reported UHC needs also reported an impact on their lives personally and economically. The most commonly reported personal impact was mental health impact, including worry, anxiety, and stress (67.38%). The most common economic impact reported due to UHC needs was increased use of over-the-counter drugs (33.16%) and increased healthcare costs (17.20%). CONCLUSIONS UHC needs are presented in the Nepalese immigrant population. Accessibility to healthcare is limited for several reasons: waiting time, cost, distance, and unavailability of services. UHC needs impact individuals' personal health, daily life activities, and financial capacity. Strategies to improve access to PHC for disadvantaged populations are crucial and need to be tackled effectively.
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Affiliation(s)
- Bishnu Bahadur Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Mohammad Z. I. Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Rudra Dahal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 1M4, Canada
| | - Kalpana Thapa Bajgain
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Community Scholar and Citizen Researcher, Nepalese-Canadian Community, Calgary, AB T2N 1N4, Canada
| | - Kamala Adhikari
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Population and Public Health, Alberta Health Services, Calgary, AB T2W 1S7, Canada
| | - Nashit Chowdhury
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Tanvir C. Turin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Department of Family Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Kourgiantakis T, Lee E, Kosar AKT, Tait C, Lau CKY, McNeil S, Craig S, Ashcroft R, Williams CC, Goldstein AL, Chandrasekera U, Sur D, Henderson JL. Youth cannabis use in Canada post-legalization: service providers' perceptions, practices, and recommendations. Subst Abuse Treat Prev Policy 2023; 18:36. [PMID: 37349741 PMCID: PMC10288694 DOI: 10.1186/s13011-023-00550-1] [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: 04/21/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND In 2018, Canada legalized recreational cannabis use with the purpose of protecting youth and restricting access. However, concerns have been raised that this objective has not been met as rates of cannabis use among youth aged 16-24 have not declined. Youth cannabis use is associated with various adverse effects including psychosis, anxiety, depression, suicidality, respiratory distress, cannabinoid hyperemesis syndrome, and intoxications. Service providers play a crucial role in addressing youth cannabis use. This study aimed to understand Ontario service providers' perceptions, practices, and recommendations on youth cannabis use. METHODS This mixed method study included a survey and two focus groups. The survey was distributed to mental health service providers serving youth aged 16-24 across Ontario who were given the option to participate in a focus group. The survey included closed and open-ended questions regarding perceptions, practices, and recommendations, while the focus groups explored these categories in greater depth. Descriptive statistics were used to analyze close-ended questions and interpretative content analysis was applied for open-ended questions. Focus group data were analyzed using thematic analysis. RESULTS The survey was completed by 160 service providers and 12 participated in two focus groups. Regarding perceptions, 60% of survey participants agreed with legalization, 26% had a strong understanding of medical versus recreational cannabis, 84% believed that cannabis has physical and mental health risks, and 49% perceived stigmatization. Less than half of the survey participants reported screening or assessing cannabis use, 16% stated they are highly familiar with treating cannabis use, and 67% reported that they rarely work with families. Subthemes identified in the focus groups under perceptions included normalization and stigmatization, harms for youth, and stigma, racism, and discrimination. Subthemes under practice included cannabis not being the primary focus, challenges with screening, assessment, and intervention, and referral to specialized services. Both the survey and focus group participants recommended increasing public education, enhancing service provider training, improving regulation and policies, reducing stigma and minimization, improving service access, and providing more culturally responsive services. CONCLUSION Youth cannabis use in Canada remains a significant public health concern, necessitating a more comprehensive plan to protect Ontario youth and reduce associated harms.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - A Kumsal Tekirdag Kosar
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Christine Tait
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie K Y Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Sandra McNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Shelley Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Uppala Chandrasekera
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Deepy Sur
- Ontario Association of Social Workers (OASW), Toronto, ON, Canada
| | - J L Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Department of Psychiatry, Centre for Addiction and Mental Health (CAMH), University of Toronto, Toronto, ON, Canada
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Kourgiantakis T, Markoulakis R, Lee E, Hussain A, Lau C, Ashcroft R, Goldstein AL, Kodeeswaran S, Williams CC, Levitt A. Access to mental health and addiction services for youth and their families in Ontario: perspectives of parents, youth, and service providers. Int J Ment Health Syst 2023; 17:4. [PMID: 36918893 PMCID: PMC10011786 DOI: 10.1186/s13033-023-00572-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Canadian youth (aged 16-24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. METHODS This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. RESULTS The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) "The biggest barrier in accessing mental health support is where to look," (2) "There's always going to be a waitlist," (3) "I have to have money to be healthy," (4) "They weren't really listening to my issues," (5) "Having more of a welcoming and inclusive system," and (6) "Health laws aren't doing what they need to do." CONCLUSION Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | - Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Amina Hussain
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Carrie Lau
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Abby L Goldstein
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Sugy Kodeeswaran
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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McLeod KE, Karim ME. The relationship between mood disorder diagnosis and experiencing an unmet health-care need in Canada: findings from the 2014 Canadian Community Health Survey. J Ment Health 2023; 32:11-23. [PMID: 32967489 DOI: 10.1080/09638237.2020.1818192] [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: 10/23/2022]
Abstract
BACKGROUND Despite Canada's universal health-care system, millions of Canadians experience unmet health-care needs (UHCN). People with mood disorders may be at higher risk of UHCN due to barriers such as stigma and gaps in health-care services. AIM We aimed to examine the relationship between having a diagnosed mood disorder and experiencing UHCN using a recent, nationally representative survey. METHODS Using the 2014 Canadian Community Health Survey, we used multivariate logistic regression to estimate the association between mood disorder and UHCN in the past 12 months, adjusting for sociodemographic variables and health status. RESULTS Among 52,825 respondents, 11.8% reported UHCN. Respondents with a diagnosed mood disorder were more likely to report UHCN [adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38, 1.89]. Among respondents with a regular doctor, people with mood disorders were still more likely to report UHCN (OR 1.63, 95% CI 1.38, 1.93). Sensitivity analyses using propensity score and missing data imputation approaches resulted in similar estimates. CONCLUSIONS Adults diagnosed with a mood disorder are more likely to report UHCN in the past year, even those with a regular doctor. Our findings suggest that barriers beyond physician attachment may impact access to care for people with mood disorders.
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Affiliation(s)
- Katherine E McLeod
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, Vancouver, BC, Canada
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Khattar J, Anderson LN, De Rubeis V, de Groh M, Jiang Y, Jones A, Basta NE, Kirkland S, Wolfson C, Griffith LE, Raina P. Unmet health care needs during the COVID-19 pandemic among adults: a prospective cohort study in the Canadian Longitudinal Study on Aging. CMAJ Open 2023; 11:E140-E151. [PMID: 36787988 PMCID: PMC9933993 DOI: 10.9778/cmajo.20210320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic affected access to health care services in Canada; however, limited research examines the influence of the social determinants of health on unmet health care needs during the first year of the pandemic. The objectives of this study were to describe unmet health care needs during the first year of the pandemic and to investigate the association of unmet needs with the social determinants of health. METHODS We conducted a prospective cohort study of 23 972 adults participating in the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Study (April-December 2020) to identify the social determinants of health associated with unmet health care needs during the pandemic. Using logistic regression, we assessed the association between several social determinants of health on the following 3 outcomes (separately): experiencing any challenges in accessing health care services, not going to a hospital or seeing a doctor when needed, and experiencing barriers to accessing testing for SARS-CoV-2 infection. RESULTS From September to December 2020, 25% of participants experienced challenges accessing health care services, 8% did not go to a hospital or see a doctor when needed and 4% faced barriers accessing testing for SARS-CoV-2 infection. The prevalence of all 3 unmet need outcomes was lower among older age groups. Differences were observed by sex, region, education, income and racial background. Immigrants (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.09-1.27) or people with chronic conditions (OR 1.35, 95% CI 1.27-1.43) had higher odds of experiencing challenges accessing health care services and had higher odds of not going to a hospital or seeing a doctor (immigrants OR 1.26, 95% CI 1.11-1.43; chronic conditions OR 1.45, 95% CI 1.31-1.61). Prepandemic unmet health care needs were strongly associated with all 3 outcomes. INTERPRETATION Substantial unmet health care needs were reported by Canadian adults during the first year of the pandemic. The results of this study have important implications for health equity.
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Affiliation(s)
- Jayati Khattar
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Vanessa De Rubeis
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Margaret de Groh
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Ying Jiang
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Nicole E Basta
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Susan Kirkland
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Christina Wolfson
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
| | - Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact (Khattar, Anderson, De Rubeis, Jones, Griffith, Raina), McMaster University, Hamilton, Ont.; Applied Research Division (de Groh, Jiang), Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ont.; Department of Epidemiology, Biostatistics and Occupational Health (Basta, Wolfson), School of Population and Global Health, McGill University, Montréal, Que.; Department of Community Health and Epidemiology and Division of Geriatric Medicine (Kirkland), Dalhousie University, Halifax, NS
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Khattar J, Griffith LE, Jones A, De Rubeis V, de Groh M, Jiang Y, Basta NE, Kirkland S, Wolfson C, Raina P, Anderson LN. Symptoms of depression and anxiety, and unmet healthcare needs in adults during the COVID-19 pandemic: a cross-sectional study from the Canadian Longitudinal Study on Aging. BMC Public Health 2022; 22:2242. [PMID: 36456993 PMCID: PMC9713148 DOI: 10.1186/s12889-022-14633-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic disrupted access to healthcare services in Canada. Research prior to the pandemic has found that depression and anxiety symptoms were associated with increased unmet healthcare needs. The primary objective of this study was to examine if mental health was associated with perceived access to healthcare during the pandemic METHODS: A cross-sectional study was conducted using data from 23,972 participants (aged 50-96) in the Canadian Longitudinal Study on Aging COVID-19 Exit Survey (Sept-Dec 2020). We used logistic regression to estimate how the presence of depression and anxiety symptoms, defined using scores of ≥10 on the Center for Epidemiologic Studies Depression Scale and ≥10 on the Generalized Anxiety Disorder Scale, were associated with the odds of reporting: 1) challenges accessing healthcare, 2) not going to a hospital or seeing a doctor when needed, 3) experiencing barriers to COVID-19 testing. Models were adjusted for sex, age, region, urban/rural residence, racial background, immigrant status, income, marital status, work status, chronic conditions, and pre-pandemic unmet needs. RESULTS The presence of depressive (aOR=1.96; 95% CI=1.82, 2.11) and anxiety symptoms (aOR=2.33; 95% CI=2.04, 2.66) compared to the absence of these symptoms were independently associated with higher odds of challenges accessing healthcare. A statistically significant interaction with sex suggested stronger associations in females with anxiety. Symptoms of depression (aOR=2.88; 95% CI=2.58, 3.21) and anxiety (aOR=3.05; 95% CI=2.58, 3.60) were also associated with increased odds of not going to a hospital or seeing a doctor when needed. Lastly, depressive (aOR=1.99; 95% CI=1.71, 2.31) and anxiety symptoms (aOR=2.01; 95% CI=1.58, 2.56) were associated with higher odds of reporting barriers to COVID-19 testing. There was no significantly significant interaction with sex for the latter two outcomes. CONCLUSION The presence of depression and anxiety symptoms were strongly associated with perceived unmet healthcare needs during the COVID-19 pandemic. Interventions to improve healthcare access for adults with depression and anxiety during the pandemic may be necessary.
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Affiliation(s)
- Jayati Khattar
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
| | - Lauren E. Griffith
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
| | - Aaron Jones
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
| | - Vanessa De Rubeis
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
| | - Margaret de Groh
- grid.415368.d0000 0001 0805 4386Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K0A 0K9 Canada
| | - Ying Jiang
- grid.415368.d0000 0001 0805 4386Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K0A 0K9 Canada
| | - Nicole E. Basta
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
| | - Susan Kirkland
- grid.55602.340000 0004 1936 8200Department of Community Health & Epidemiology and Division of Geriatric Medicine, Dalhousie University, Halifax, Canada
| | - Christina Wolfson
- grid.14709.3b0000 0004 1936 8649Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health & Department of Medicine, McGill University, Montreal Canada & Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada
| | - Parminder Raina
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
| | - Laura N. Anderson
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St. West, Hamilton, Ontario L8S 4L8 Canada
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Chung W. Changes in Barriers That Cause Unmet Healthcare Needs in the Life Cycle of Adulthood and Their Policy Implications: A Need-Selection Model Analysis of the Korea Health Panel Survey Data. Healthcare (Basel) 2022; 10:2243. [PMID: 36360584 PMCID: PMC9691171 DOI: 10.3390/healthcare10112243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/27/2022] [Accepted: 11/04/2022] [Indexed: 01/31/2024] Open
Abstract
Using 68,930 observations selected from 16,535 adults in the Korea Health Panel Survey (2014-2018), this study explored healthcare barriers that prevent people from meeting their healthcare needs most severely during adulthood, and the characteristics that are highly associated with the barrier. This study derived two outcome variables: a dichotomous outcome variable on whether an individual has experienced healthcare needs, and a quadchotomous outcome variable on how an individual's healthcare needs ended. An analysis was conducted using a multivariable panel multinomial probit model with sample selection. The results showed that the main cause of unmet healthcare needs was not financial difficulties but non-financial barriers, which were time constraints up to a certain age and the lack of caring and support after that age. People with functional limitations were at a high risk of experiencing unmet healthcare needs due to a lack of caring and support. To reduce unmet healthcare needs in South Korea, the government should focus on lowering non-financial barriers to healthcare, including time constraints and lack of caring and support. It seems urgent to strengthen the foundation of "primary care", which is exceptionally scarce now, and to expand it to "community-based integrated care" and "people-centered care".
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul 03722, Korea
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12
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Kourgiantakis T, Edwards T, Lee E, Logan J, Vicknarajah R, Craig SL, Simon-Tucker M, Williams CC. Cannabis use among youth in Canada: a scoping review protocol. BMJ Open 2022; 12:e061997. [PMID: 35725253 PMCID: PMC9214380 DOI: 10.1136/bmjopen-2022-061997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Canadian youth (aged 15-24) have the highest rates of cannabis use globally. There are increasing concerns about the adverse effects of cannabis use on youth physical and mental health. However, there are gaps in our understanding of risks and harms to youth. This scoping review will synthesise the literature related to youth cannabis use in Canada. We will examine the relationship between youth cannabis use and physical and mental health, and the relationship with use of other substances. We will also examine prevention strategies for youth cannabis use in Canada and how the literature addresses social determinants of health. METHODS AND ANALYSIS Using a scoping review framework developed by Arksey and O'Malley, we will conduct our search in five academic databases: MEDLINE, Embase, APA PsycInfo, CINAHL and Web of Science's Core Collection. We will include articles published between 2000 and 2021, and articles meeting the inclusion criteria will be charted to extract relevant themes and analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION This review will provide relevant information about youth cannabis use and generate recommendations and gaps in the literature. Updated research will inform policies, public education strategies and evidence-based programming. Results will be disseminated through an infographic, peer-reviewed publication and presentation at a mental health and addiction conference. Ethics approval is not required for this scoping review.
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Affiliation(s)
- Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Travonne Edwards
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Eunjung Lee
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Judith Logan
- John P. Robarts Library, University of Toronto, Toronto, Ontario, Canada
| | | | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Monique Simon-Tucker
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Charmaine C Williams
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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13
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Chung W. Characteristics Associated With Financial or Non-financial Barriers to Healthcare in a Universal Health Insurance System: A Longitudinal Analysis of Korea Health Panel Survey Data. Front Public Health 2022; 10:828318. [PMID: 35372247 PMCID: PMC8971121 DOI: 10.3389/fpubh.2022.828318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
While many studies have explored the financial barriers to healthcare, there is little evidence regarding the non-financial barriers to healthcare. This study identified characteristics associated with financial and non-financial barriers to healthcare and quantified the effects of these characteristics in South Korea, using a nationally representative longitudinal survey dataset. Overall, 68,930 observations of 16,535 individuals aged 19 years and above were sampled from Korea Health Panel survey data (2014-2018). From self-reported information about respondents' experiences of unmet healthcare needs, a trichotomous dependent variable-no barrier, non-financial barrier, and financial barrier-was derived. Sociodemographics, physical and health conditions were included as explanatory variables. The average adjusted probability (AAP) of experiencing each barrier was predicted using multivariable and panel multinomial logistic regression analyses. According to the results, the percentage of people experiencing non-financial barriers was much higher than that of people experiencing financial barriers in 2018 (9.6 vs. 2.5%). Women showed higher AAPs of experiencing both non-financial (9.9 vs. 8.3%) and financial barriers (3.6 vs. 2.5%) than men. Men living in the Seoul metropolitan area showed higher AAPs of experiencing non-financial (8.7 vs. 8.0%) and financial barriers (3.4 vs. 2.1%) than those living outside it. Household income showed no significant associations in the AAP of experiencing a non-financial barrier. People with a functional limitation exhibited a higher AAP of experiencing a non-financial barrier, for both men (17.8 vs. 7.8%) and women (17.4 vs. 9.0%), than those without it. In conclusion, people in South Korea, like those in most European countries, fail to meet their healthcare needs more often due to non-financial barriers than financial barriers. In addition, the characteristics associated with non-financial barriers to healthcare differed from those associated with financial barriers. This finding suggests that although financial barriers may be minimised through various policies, a considerable degree of unmet healthcare needs and disparity among individuals is very likely to persist due to non-financial barriers. Therefore, current universal health insurance systems need targeted policy instruments to minimise non-financial barriers to healthcare to ensure effective universal health coverage.
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Affiliation(s)
- Woojin Chung
- Department of Health Policy and Management, Graduate School of Public Health, Yonsei University, Seoul, South Korea
- Institute of Health Services Research, Yonsei University, Seoul, South Korea
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Mahapatro SR, James K, Mishra US. Intersection of class, caste, gender and unmet healthcare needs in India: Implications for health policy. HEALTH POLICY OPEN 2021. [DOI: 10.1016/j.hpopen.2021.100040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Hyejin L, Bumjo O, Sunyoung K, Kiheon L. ADL/ IADL dependencies and unmet healthcare needs in older persons: A nationwide survey. Arch Gerontol Geriatr 2021; 96:104458. [PMID: 34147824 DOI: 10.1016/j.archger.2021.104458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 06/06/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To determine the impact of overall and component-wise activities for daily living (ADL) as well as instrumental activities of daily living (IADL) dependencies on unmet healthcare needs in older adults. MATERIALS AND METHODS Cross-sectional analyses were performed based on a National Survey of Older Koreans. A total of 10,082 participants aged ≥ 65 years were included. All data were collected through standardized, personal interviews with participants and their representatives. Logistic regression was used to analyse the risk of unmet healthcare needs, with or without adjustment. RESULTS Amongst all participants, 734 (7.2%) had ADL dependency. Participants with ADL dependency had lower income, education level, and perceived health status (p<0.001). The adjusted odds ratio (aOR) for the risk of unmet healthcare needs was 1.52 (95%, confidence interval [CI] 1.19-1.95) for ADL and 1.54 (95%, CI 1.28-1.86) for IADL. When men have ADL dependency, aOR of unmet healthcare needs was higher than that of women (aOR 1.89, 95% CI 1.15 - 3.11; aOR 1.65, 95% CI 1.15 - 2.36, respectively) and IADL showed the same trend. Any dependency on ADL or IADL was associated with higher risk of unmet healthcare needs, whether adjusted or not (p<0.001). CONCLUSIONS Older adults with ADL or IADL dependency had higher risks of unmet healthcare needs than their independent counterparts. In addition to mobility problems, other components were related to unmet healthcare needs. Therefore, to reduce unmet healthcare needs, integration of health and social care that supports ADL or IADL dependency should be considered.
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Affiliation(s)
- Lee Hyejin
- Department of Family Medicine, Seoul National University Bundang Hospital, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Republic of Korea
| | - Oh Bumjo
- Department of Family Medicine, College of Medicine, Seoul National University, Republic of Korea; Department of Family Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Republic of Korea
| | - Kim Sunyoung
- Department of Family Medicine, Kyung Hee University, Republic of Korea
| | - Lee Kiheon
- Department of Family Medicine, Seoul National University Bundang Hospital, Republic of Korea; Department of Family Medicine, College of Medicine, Seoul National University, Republic of Korea.
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Başar D, Dikmen FH, Öztürk S. The prevalence and determinants of unmet health care needs in Turkey. Health Policy 2021; 125:786-792. [PMID: 33896593 DOI: 10.1016/j.healthpol.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/28/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
This study aims to examine the prevalence and determinants of unmet health care needs in Turkey. The nationally representative "Health Survey" data for the latest available year, 2016, is used in the analysis. The reasons for unmet health care needs are divided into three categories which are waiting time, affordability (cost), and the distance to health facilities. The probit methodology is employed to investigate the factors affecting unmet health care needs. Approximately 25% of participants (4392 of 17242) reported an unmet need for health care. Overall, females, individuals in lower income groups, those with chronic illness, those with lower education levels and those in younger age groups are more likely to report unmet health care needs. Estimation results point out that age and having a chronic illness have more influence on the reporting of unmet health care needs as compared to other variables included in the model. Therefore, it seems necessary to reorganize the health care system in Turkey to target the needs of individuals with chronic diseases.
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Affiliation(s)
- Dilek Başar
- Department of Economics, Faculty of Administrative Sciences, Hacettepe University, Turkey.
| | - Fatih Hakan Dikmen
- Department of Economics, Faculty of Administrative Sciences, Ankara Hacı Bayram Veli University, Turkey.
| | - Selcen Öztürk
- Department of Economics, Faculty of Administrative Sciences, Hacettepe University, Turkey.
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Jung B, Ha IH. Determining the reasons for unmet healthcare needs in South Korea: a secondary data analysis. Health Qual Life Outcomes 2021; 19:99. [PMID: 33743725 PMCID: PMC7981839 DOI: 10.1186/s12955-021-01737-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/09/2021] [Indexed: 12/02/2022] Open
Abstract
Background “Unmet healthcare needs” refers to the situation in which patients or citizens cannot fulfill their medical needs, likely due to socioeconomic reasons. The purpose of this study was to analyze factors related to unmet healthcare needs among South Korean adults. Methods We used a retrospective cross-sectional study design. This nationwide-based study included the data of 26,598 participants aged 19 years and older, which were obtained from the 2013–2017 Korea National Health and Nutrition Examination Surveys. Using multiple logistic regression models, we analyzed the associations between factors that influence unmet healthcare needs and participants’ subgroups. Results Despite South Korea’s universal health insurance system, in 2017, 9.5% of South Koreans experienced unmet healthcare needs. In both the male and female groups, younger people (age 19–39) had a higher odds ratio (OR) of experiencing unmet healthcare needs compared to older people (reference: age ≥ 60) (men: OR 1.83, 95% confidence interval [CI] = 1.35–2.48; women: OR 1.42, 95% CI 1.12–1.81). In particular, unlike men, women’s unmet healthcare needs increased as their incomes decreased (1 quartile OR 1.55, 2 quartiles OR 1.29, 3 quartiles OR 1.26). Men and women showed a tendency to have more unmet healthcare needs with less exercise, worse subjective health state, worse pain, and a higher degree of depression. Conclusions The contributing factors of unmet healthcare needs included having a low socioeconomic status, high stress, severe pain, and severe depression. Considering our findings, we suggest improving healthcare access for those with low socioeconomic status. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01737-5.
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Affiliation(s)
- Boyoung Jung
- Department of Health Administration, Hanyang Women's University, 200 Salgoji-gil, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, 3F, 538 Gangnam-daero, Gangnam-gu, Seoul, 06110, Republic of Korea.
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Vahedi S, Torabipour A, Takian A, Mohammadpur S, Olyaeemanesh A, Kiani MM, Mohamadi E. Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study. BMC Public Health 2021; 21:457. [PMID: 33676480 PMCID: PMC7937318 DOI: 10.1186/s12889-021-10477-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran's health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. METHODS We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. RESULTS About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. CONCLUSION It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.
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Affiliation(s)
- Sajad Vahedi
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amin Torabipour
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amirhossein Takian
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, 2nd Floor, Main Building, Poursina Ave, Tehran, Iran. .,Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), 2nd Floor, Main Building, Poursina Ave, Tehran, Iran.
| | - Saeed Mohammadpur
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.,National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), 2nd Floor, Main Building, Poursina Ave, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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19
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Park SM. Effects of healthcare access and financial status on self-rated health among adults living alone in South Korea. PSYCHOL HEALTH MED 2021; 27:1107-1116. [PMID: 33434078 DOI: 10.1080/13548506.2021.1874433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Assessments of the overall health status of people living alone are important for developing health promotion programs and delivering appropriate health services. In the context of universal social health insurance system of South Korea, the relationship between failure to access health-care and self-rated health among adults living alone has given little attention. In addition, the influence of objective financial status on self-rated health in adults living alone has not explored so far. The sample of the present study comprised 4,852 adults who participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. The main finding was that the unmet health-care needs resulting from the inability to access health-care services during the previous 12 months was independently associated with fair or poor self-rated health, especially for women living alone. Having an income below the subsistence level was significantly associated with fair or poor self-rated health among women living alone. The findings of this study demonstrate the need for policies enabling appropriate delivery of health-care services, especially for women living alone. It is necessary to provide community-based monitoring programs related to general health for women living alone with a household income below the minimum cost-of-living.
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Affiliation(s)
- Sang-Mi Park
- Department of Health Administration, Hanyang Women's University, Seoul, Republic of Korea
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20
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Noh E. Intergenerational Differences in Factors Affecting Unmet Health Care Needs in South Korea: Comparison of Middle-aged and Older Adults. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2021. [DOI: 10.1080/15350770.2021.1868242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Eunjeong Noh
- Seoul National University Medical Research Center, Seoul, Republic of Korea
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21
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The Effects of Social Networks of the Older Adults with Limited Instrumental Activities of Daily Living on Unmet Medical Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010027. [PMID: 33374511 PMCID: PMC7793059 DOI: 10.3390/ijerph18010027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022]
Abstract
This study was conducted to identify the effects of social networks on unmet medical needs among older adults with limited instrumental activities of daily living (IADL) who live in a community. This study analyzed data from 2281 older adults with limited IADL from the 2017 National Survey of Older Koreans. Data were analyzed using descriptive statistics, X2 tests, t-tests, and logistic regression analysis. About 73.0% of the subjects were female and 15.8% of the subjects had experienced unmet medical needs. The predictors of unmet medical needs according to gender are as follows: annual household income, participation in social activities, and physical support for male subjects and annual household income, number of chronic diseases, living alone in a household, living with others in a household, frequency of contacting close friends, and emotional support for female subjects. The findings of this study will be utilized as a basis for establishing relevant measures to enable older adults to receive proper medical services by heightening the understanding of the gap between medical service use and the medical needs of older adults with limited IADL.
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22
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Zhong BL, Zhou DY, He MF, Li Y, Li WT, Ng CH, Xiang YT, Chiu HFK. Mental health problems, needs, and service use among people living within and outside Wuhan during the COVID-19 epidemic in China. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1392. [PMID: 33313137 PMCID: PMC7723535 DOI: 10.21037/atm-20-4145] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Crisis mental health services for the general population are an essential component in combating the COVID-19 epidemic. To facilitate planning of mental health services, empirical data on mental health problems and service utilization of populations affected by the epidemic are urgently needed. This study investigated the prevalence of mental health problems of residents within and outside Wuhan, China, as well as their patterns of mental health service utilization. Methods From January 27 to February 2, 2020, an online cross-sectional survey recruited residents from 4 subpopulations: Wuhan residents (n=2,617), migrants from Wuhan (those who left Wuhan before lockdown, n=930), other Hubei residents (n=633), and residents of other provinces of China (“other residents”, n=3,561). Participants’ mental health problems and patterns of utilization of mental health services in recent days were assessed with standardized assessments. Results Among the 4 groups, Wuhan residents had the highest rate of any type of mental health problem (i.e., psychological distress: 41.9%), followed by migrants from Wuhan (34.2%), other Hubei residents (24.8%), and other residents (21.1%). Rates of perceived mental health needs and utilization of mental health services during recent days were 10.2% and 1.9% for Wuhan residents, 8.4% and 1.8% for migrants from Wuhan, 6.2% and 1.1% for other Hubei residents, and 6.4% and 1.0% for other residents, respectively. Overall, 63.0% mental health service users received services via internet and telephone, and 83.1% participants with perceived mental health needs ascribed their lack of help-seeking to barriers to accessibility and availability. Conclusions The COVID-19 epidemic is associated with unprecedented levels of mental health problems and needs in affected residents. To address the unmet mental health needs, internet- and telephone-based mental health services should be widely provided to residents, especially those in the worst-affected regions.
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Affiliation(s)
- Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - De-Yi Zhou
- Department of Psychiatry, The Affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Min-Fu He
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, China
| | - Yi Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Wen-Tian Li
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.,Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China.,Center for Cognition and Brain Sciences, University of Macau, Macao, China
| | - Helen Fung-Kum Chiu
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
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23
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Chowdhury N, Naeem I, Ferdous M, Chowdhury M, Goopy S, Rumana N, Turin TC. Unmet Healthcare Needs Among Migrant Populations in Canada: Exploring the Research Landscape Through a Systematic Integrative Review. J Immigr Minor Health 2020; 23:353-372. [DOI: 10.1007/s10903-020-01086-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2020] [Indexed: 11/29/2022]
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24
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Evolution of the determinants of unmet health care needs in a universal health care system: Canada, 2001-2014. HEALTH ECONOMICS POLICY AND LAW 2020; 16:400-423. [PMID: 32807251 DOI: 10.1017/s1744133120000250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While ensuring adequate access to care is a central concern in countries with universal health care coverage, unmet health care needs remain prevalent. However, subjective unmet health care needs (SUN) can arise from features of a health care system (system reasons) or from health care users' choices or constraints (personal reasons). Furthermore, investigating the evolution of SUN within a health care system has rarely been carried out. We investigate whether health needs, predisposing factors and enabling factors differentially affect SUN for system reasons and SUN for personal reasons, and whether these influences are stable over time, using representative data from the Canadian Community Health Surveys from 2001 to 2014. While SUN slightly decreased overall during our period of observation, the share of SUN for system reasons increased. Some key determinants appear to consistently increase SUN reporting over all our observation periods, in particular being a woman, younger, in poorer health or not having a regular doctor. The distinction between personal and system reasons is important to better understand individual experiences. Notably, women report more SUN for system reasons and less for personal reasons, and reporting system reasons increases with age. Given this stability over time, our results may inform health policymakers on which subpopulations to target to ensure access to health care is universal.
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25
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Tuck A, Oda A, Hynie M, Bennett-AbuAyyash C, Roche B, Agic B, McKenzie K. Unmet Health Care Needs for Syrian Refugees in Canada: A Follow-up Study. J Immigr Minor Health 2020; 21:1306-1312. [PMID: 30617545 DOI: 10.1007/s10903-019-00856-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unmet health care needs are under explored among refugees. Previously we found unmet health care needs in Syrian refugees may be higher than in the general Canadian population (Oda et al. CMAJ Open 5(2):E354-E358, 2017; Oda et al. J Immigr Minor Health, 2018. https://doi.org/10.1007/s10903-018-0780-z). This follow-up study with Syrian refugees who entered Canada between July 2015 and July 2016 aimed to understand if there are changes in unmet health care needs 6 months to a year after baseline collection. The number reporting unmet needs was high (42.6%). Although some refugees had their needs met, unmet health needs persist, and it seems that they are linked with sponsorship pathway and post-migration socio-economic position. While caution should be used generalizing these results, they do suggest that greater coordination between services may be needed as many of the refugees report unmet needs within months of arriving and continue to report needs after being here for a period up to 2 years.
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Affiliation(s)
- Andrew Tuck
- Centre for Addiction and Mental Health, 2017-33 Russell St, Toronto, ON, Canada.
| | - Anna Oda
- Centre for Addiction and Mental Health, 2017-33 Russell St, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Michaela Hynie
- Department of Psychology, York University, Toronto, ON, Canada
| | | | | | - Branka Agic
- Centre for Addiction and Mental Health, 2017-33 Russell St, Toronto, ON, Canada
| | - Kwame McKenzie
- Centre for Addiction and Mental Health, 2017-33 Russell St, Toronto, ON, Canada
- Wellesley Institute, Toronto, ON, Canada
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26
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LaChance J, Booth R, Befus D. Exploring unmet healthcare needs, healthcare access, and the use of practitioner based complementary and alternative medicine in adults with chronic pain. Contemp Nurse 2020; 56:105-119. [PMID: 32193985 DOI: 10.1080/10376178.2020.1743192] [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: 10/24/2022]
Abstract
Background: Chronic pain is a complex condition frequently encountered in nursing practice, resulting in negative multidimensional effects on the individual and healthcare system. Increasingly, people with chronic pain are turning to Complementary and Alternative Medicine (CAM) to manage their pain. Objectives: To explore the relationship between healthcare access, unmet healthcare needs, and practitioner-based Complementary and Alternative Medicine use in adults with chronic pain. Design: A secondary analysis of 1688 individuals ≥18 years old self-reporting chronic pain from Cycle 9 of the Canadian National Population Health Survey. Methods: Multivariate logistic regression and descriptive statistics. Results: When controlling for demographics and health status indicators, the presence of unmet healthcare needs was found to predict CAM use (p < 0.001; OR 2.02; CI [1.45, 2.81]), along with sex, education, income, employment, and restriction of activities. Conclusion: People may be using CAM due to shortcomings of the conventional healthcare system, with implications for policymakers and healthcare professions to develop more integrative strategies to improve chronic pain management. Impact statement: Having unmet healthcare needs is associated with two-fold increased odds of using Complementary and Alternative Medicine in Canadian adults with chronic pain.
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Affiliation(s)
- Jessica LaChance
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, Western University, London, Canada.,Department of Social Science and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
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27
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Wells J, Kennedy C, Bain H, Lee SH. The experiences of older adults with a diagnosed functional mental illness, their carers and healthcare professionals in relation to mental health service delivery: An integrative review. J Clin Nurs 2019; 29:31-52. [DOI: 10.1111/jocn.15067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Julia Wells
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
| | - Catriona Kennedy
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
| | - Heather Bain
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
| | - Siew Hwa Lee
- School of Nursing and Midwifery Robert Gordon University Aberdeen UK
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28
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Kwon I, Shin O, Park S, Kwon G. Multi-Morbid Health Profiles and Specialty Healthcare Service Use: A Moderating Role of Poverty. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1956. [PMID: 31159464 PMCID: PMC6604021 DOI: 10.3390/ijerph16111956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022]
Abstract
Increasing life expectancy in the USA makes a better understanding of the heterogeneous healthcare needs of the aging population imperative. Many aging studies have discovered multimorbid health problems focusing mainly on various physical health conditions, but not on combined mental or behavioral health problems. There is also a paucity of studies with older adults who use professional healthcare services caring for their mental and substance-related conditions. This study aims to enhance the knowledge of older peoples' complex healthcare needs involving physical, mental, and behavioral conditions; examine the relationship between multi-morbid health profiles and specialty healthcare service utilization; and investigate its association to poverty. The study data were derived from the National Survey on Drug Use and Health (NSDUH) in 2013 (n = 6296 respondents aged 50 years and older). To identify overall health conditions, nine indicators, including physical, mental, and substance/alcohol, were included. Healthcare service utilization was measured with four mutually exclusive categories: No treatment, mental health treatment only, substance use treatment only, and both. We identified four health profiles: Healthy (82%), having physical health problems (6%), physical and mental health problems (4%), and behavioral problems (8%). Older people's health profiles were differentially associated with healthcare use. Those living in poverty with both physical and mental health problems or substance/alcohol health problems were less likely to receive mental health and substance use treatments than those with more financial resources. Implications for geriatric healthcare practices and policy are discussed.
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Affiliation(s)
- Ilan Kwon
- School of Social Work at Michigan State University, Baker Hall, 655 Auditorium Road, East Lansing, MI 48824, USA.
| | - Oejin Shin
- School of Social Work at University of Illinois Urbana-Champaign, 1010 W Nevada St, Urbana, IL 61801, USA.
| | - Sojung Park
- Brown School of Social Work at Washington University, 1 Brookings Drive, Saint Louis, MO 63130, USA.
| | - Goeun Kwon
- Brown School of Social Work at Washington University, 1 Brookings Drive, Saint Louis, MO 63130, USA.
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29
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Gibson G, Grignon M, Hurley J, Wang L. Here comes the SUN: Self-assessed unmet need, worsening health outcomes, and health care inequity. HEALTH ECONOMICS 2019; 28:727-735. [PMID: 31020778 DOI: 10.1002/hec.3877] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/04/2019] [Accepted: 02/18/2019] [Indexed: 06/09/2023]
Abstract
Utilization-based approaches have predominated the measurement of socioeconomic-related inequity in health care. This approach, however, can be misleading when preferences over health and health care are correlated with socioeconomic status, especially when the underlying focus is on equity of access. We examine the potential usefulness of an alternative approach to assessing inequity of access using a direct measure of possible barriers to access-self-reported unmet need (SUN)-which is documented to vary with socioeconomic status and is commonly asked in health surveys. Specifically, as part of an assessment of its external validity, we use Canadian longitudinal health data to test whether self-reported unmet need in one period is associated with a subsequent deterioration in health status in a future period, and find that it is. This suggests that SUN does reflect in part reduced access to needed health care, and therefore may have a role in assessing health system equity as a complement to utilization-based approaches.
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Affiliation(s)
- Grant Gibson
- Economics, McMaster University, Hamilton, Ontario, Canada
| | - Michel Grignon
- Economics, McMaster University, Hamilton, Ontario, Canada
- CHEPA, McMaster University, Hamilton, Ontario, Canada
| | - Jeremiah Hurley
- Economics, McMaster University, Hamilton, Ontario, Canada
- CHEPA, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- CHEPA, McMaster University, Hamilton, Ontario, Canada
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30
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The association of health care access and utilization with self-perceived health in South Korea: the significance of age. J Biosoc Sci 2019; 52:1-13. [PMID: 31109384 DOI: 10.1017/s0021932019000191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Even though South Korea's universal health care system was established in 1989, many South Koreans continue to encounter obstacles in their attempts to access health care. Previous studies have not investigated the relationship between health care access and utilization and perceived health in the context of a universal health care system that implements a mandatory social health insurance policy. The objective of this study was to evaluate the influence of health care access and use of preventive health care services on self-rated health among young and middle-aged adults in Korea. The sample consisted of 1242 young adults aged 20-39 years and 2389 middle-aged adults aged 40-64 years who had participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. Using multiple logistic regression analysis, the association between health care access and use of preventive health care services and perceived poor health among young adults and middle-aged adults was assessed. The main finding was that a history of unmet health care requirements during the past 12 months was strongly associated with fair and poor self-rated health, especially among young adults. Additionally, middle-aged adults who had attended medical check-ups during the preceding 2 years reported poorer self-rated health. This study's findings suggest that, despite South Korea's universal public insurance system, there remains the need to improve access to health care services, especially among young adults. As a health improvement strategy, it is imperative that measures be taken to promote the availability of health care services when they are required and to solve any of the various individual accessibility problems, such as cost, particularly with young adults in mind.
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31
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Unmet Mental Health Care Needs among Asian Americans 10⁻11 Years After Exposure to the World Trade Center Attack. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071302. [PMID: 30979006 PMCID: PMC6480170 DOI: 10.3390/ijerph16071302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 11/17/2022]
Abstract
This study investigated the prevalence of unmet mental health care needs (UMHCN) and their associated factors among 2344 Asian Americans directly exposed to the World Trade Center (WTC) attack 10-11 years afterwards. Given the pervasive underutilization of mental health services among Asians, their subjective evaluation of unmet needs could provide more nuanced information on disparities of service. We used the WTC Health Registry data and found that 12% of Asian Americans indicated UMHCN: 69% attributing it to attitudinal barriers, 36% to cost barriers, and 29% to access barriers. Among all the factors significantly related to UMHCN in the logistic model, disruption of health insurance in the past year had the largest odds ratio (OR = 2.37, 95% confidence interval: 1.61-3.48), though similar to functional impairment due to mental disorders. Post-9/11 mental health diagnosis, probable mental disorder and ≥14 poor mental health days in the past month were also associated with greater odds of UMHCN, while greater social support was associated with lower odds. Results suggest that continued outreach efforts to provide mental health education to Asian communities to increase knowledge about mental illness and treatment options, reduce stigmatization of mental illness, and offer free mental health services are crucial to address UMHCN.
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32
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Bataineh H, Devlin RA, Barham V. Unmet health care and health care utilization. HEALTH ECONOMICS 2019; 28:529-542. [PMID: 30693596 DOI: 10.1002/hec.3862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/16/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
The objective of this study is to examine the causal effect of health care utilization on unmet health care needs. An IV approach deals with the endogeneity between the use of health care services and unmet health care, using the presence of drug insurance and the number of physicians by health region as instruments. We employ three cycles of the Canadian Community Health Survey confidential master files (2003, 2005, and 2014). We find a robustly negative relationship between health care use and unmet health care needs. One more visit to a medical doctor on average decreases the probability of reporting unmet health care needs by 0.014 points. The effect is negative for the women-only group whereas it is statistically insignificant for men; similarly, the effect is negative for urban dwellers but insignificant for rural ones. Health care use reduces the likelihood of reporting unmet health care. Policies that encourage the use of health care services, like increasing the coverage of public drug insurance and increasing after hours accessibility of physicians, can help reduce the likelihood of unmet health care.
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Affiliation(s)
- Hana Bataineh
- Department of Economics, University of Ottawa, Ottawa, Canada
| | | | - Vicky Barham
- Department of Economics, University of Ottawa, Ottawa, Canada
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33
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Corscadden L, Callander EJ, Topp SM. Who experiences unmet need for mental health services and what other barriers to accessing health care do they face? Findings from Australia and Canada. Int J Health Plann Manage 2019; 34:761-772. [PMID: 30657197 DOI: 10.1002/hpm.2733] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To examine factors associated with unmet need for mental health services and links with barriers to access to care more broadly. METHODOLOGY The Commonwealth Fund International Health Policy Surveys from 2013 and 2016 were used to explore factors associated with unmet need for adults who experienced emotional distress for 1320 respondents in Australia and 2284 in Canada. FINDINGS Over one in five adults in Australia (21%) and in Canada (25%) experienced emotional distress, just over half said they received professional help (51% in Australia, 59% in Canada). The majority of those who did not get help indicated did not want to see a professional (37% in Australia, 30% in Canada). For those who did seek help, the factors associated with not receiving care included lower income, higher out-of-pocket health care costs, and poorer health. When compared with people with met needs, those with unmet needs for mental health services were more likely to also experience affordability, medication, and trust-related access barriers (AOR range 2.41 to 7.49 for the two countries, P < 0.01). CONCLUSION Including unmet needs for mental health services as part of regular reporting on access to care may bring attention to access barriers for people with mental health conditions.
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Affiliation(s)
- Lisa Corscadden
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland, New South Wales, Australia.,Bureau of Health Information, Chatswood, Sydney, New South Wales, Australia
| | - Emily J Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland, New South Wales, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Vet Sciences, James Cook University, Queensland, New South Wales, Australia
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34
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Tian W. Investigating unmet health care needs under the National Health Insurance program in Taiwan: A latent class analysis. Int J Health Plann Manage 2018; 34:572-582. [DOI: 10.1002/hpm.2717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/05/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Wei‐Hua Tian
- Department of Economics, College of Social ScienceNational Cheng Kung University Tainan Taiwan
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35
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Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women. Arch Womens Ment Health 2018; 21:757-764. [PMID: 29846799 DOI: 10.1007/s00737-018-0864-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.
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Hwang J. Understanding reasons for unmet health care needs in Korea: what are health policy implications? BMC Health Serv Res 2018; 18:557. [PMID: 30012117 PMCID: PMC6048816 DOI: 10.1186/s12913-018-3369-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To ensure equal access to necessary care regardless of an individual's socioeconomic status, it is crucial to understand the factors that act as barriers. Unmet health care needs can arise for a variety of complex reasons, including personal choice, financial barriers, or lack of services, and each of these reasons requires a different policy approach. Researchers have advocated for a more granular measure of unmet health care need for better policy implication. This study aimed to assess various factors associated with different types of unmet health care needs in Korea. METHODS The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012 was used to analyze responses from 17,610 individuals over age 19. To measure the unmet needs of this population, self-reported experience in the past 1 year was used, and individual's reasons for unmet need were sorted into three distinct categories - availability, acceptability, accessibility. Four different logistic regression models stratified by gender were used to examine the relationship between socioeconomic factors and unmet needs. RESULTS While income was not a significant factor for men, women with lower incomes showed a higher likelihood of experiencing unmet need. In addition, women with lower incomes showed higher odds of having acceptability-related unmet needs during the past 1 year compared to men. Education and income levels were associated with accessibility-related unmet needs for both women and men. CONCLUSION As unmet health care needs are considered to be a critical indicator of a country's health care system, it is crucial to identify and eliminate any obstacles that prevent access to health care services. Under the current universal health care system in Korea, women, particularly those of lower income and lower educational levels, have limited access to necessary health care services. A gender-specific health care plan is recommended to reduce the higher rate of unmet needs experienced by this group. To reduce accessibility-related unmet needs, increasing available services for younger age groups, reflecting their needs of health services, needs to be considered.
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Affiliation(s)
- Jongnam Hwang
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, Korea.
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Ju YJ, Kim TH, Han KT, Lee HJ, Kim W, Ah Lee S, Park EC. Association between unmet healthcare needs and health-related quality of life: a longitudinal study. Eur J Public Health 2018; 27:631-637. [PMID: 28122811 DOI: 10.1093/eurpub/ckw264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background As life expectancy has increased overall, health-related quality of life is now more important than ever. This is especially relevant in countries such as South Korea that are concerned about unmet healthcare needs and health-related quality of life (HRQoL). Thus, we investigated the relationship between unmet healthcare needs and HRQoL in the general population. Methods We used data from the 2011 to 2013 Korea Health Panel Survey, which included data from 8150 baseline participants of 19 years of age or older. We measured HRQoL using the EQ-5D and EQ-VAS indices. In addition, we used generalized estimating equations to perform a longitudinal regression analysis. Results Approximately 13.1% of the participants (n = 1068) experienced unmet healthcare needs. Individuals with unmet healthcare needs due to economic hardship tended to have lower values than those without unmet healthcare needs for EQ-5D and EQ-VAS indices (EQ-5D: -2.688, P < 0.0001; EQ-VAS: -5.256, P < 0.0001). Additionally, when stratified by gender, both male and female subjects who had unmet healthcare needs and low economic status had a drastic decrease in HRQoL regardless of the reasons for their unmet healthcare needs. Conclusions Unmet healthcare needs influences HRQoL, which was more pronounced in economically vulnerable groups. Thus, interventions to address HRQoL problems should focus on implementing a guarantee of healthcare services for economically vulnerable groups.
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Affiliation(s)
- Yeong Jun Ju
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Hospital Administration, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyo Jung Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Woorim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sang Ah Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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McGeoch G, Holland K, Kerdemelidis M, Elliot N, Shand B, Fink C, Dixon A, Gullery C. Unmet need for referred services as measured by general practice. J Prim Health Care 2018. [PMID: 29530138 DOI: 10.1071/hc17044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.
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Affiliation(s)
- Graham McGeoch
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Kieran Holland
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Melissa Kerdemelidis
- Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand
| | - Nikki Elliot
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Brett Shand
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Catherine Fink
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Anne Dixon
- Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand
| | - Carolyn Gullery
- Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand
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Kim JR, Jeong B, Park KS, Kang YS. Associations of Generalized Trust and Social Participation at the Individual Level with Unmet Healthcare Needs in Communities with High Mortality. J Korean Med Sci 2018; 33:e84. [PMID: 29495134 PMCID: PMC5835583 DOI: 10.3346/jkms.2018.33.e84] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/18/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate whether generalized trust and/or social participation at an individual level have negative associations with unmet healthcare needs. METHODS Door-to-door interviews were conducted by trained interviewers to collect information. The 8,800 study participants included 220 adults sampled systematically using the resident registration database from 40 sub-municipal-level administrative units in Korea. Unmet healthcare needs were measured subjectively by the following question: "During the past 12 months, was there ever a time when you felt that you needed healthcare (excluding dental care) but did not receive it?" The responses were classified as either "yes" or "no." RESULTS The adjusted odds ratios (ORs) for unmet healthcare needs based on one positive response, two positive responses, and three positive responses to the three items of generalized trust compared to no positive responses were 0.92 (95% confidence interval [CI], 0.77-1.09), 0.90 (95% CI, 0.74-1.09), and 0.73 (95% CI, 0.61-0.87), respectively. The adjusted ORs for unmet healthcare needs based on social participation only in informal organizations, only in formal organizations, and in both informal and formal organizations compared to no social participation were 0.83 (95% CI, 0.71-0.98), 0.97 (95% CI, 0.77-1.21), and 0.97 (95% CI, 0.82-1.15), respectively. The covariates included in the multiple logistic regression were sociodemographic variables (gender, age, marital status, educational level, occupation, food security, and administrative unit), self-rated health, and perceived stress. CONCLUSION Therefore, generalized trust and social participation in informal organizations can decrease the incidence of unmet healthcare needs.
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Affiliation(s)
- Jang Rak Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea.
| | - Baekgeun Jeong
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Yune Sik Kang
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
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Unmet healthcare needs among indigenous peoples in Canada: findings from the 2006 and 2012 Aboriginal Peoples Surveys. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-017-0887-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Henderson J, Javanparast S, MacKean T, Freeman T, Baum F, Ziersch A. Commissioning and equity in primary care in Australia: Views from Primary Health Networks. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:80-89. [PMID: 28608451 DOI: 10.1111/hsc.12464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This paper reports findings from 55 stakeholder interviews undertaken in six Primary Health Networks (PHNs) in Australia as part of a study of the impact of population health planning in regional primary health organisations on service access and equity. Primary healthcare planning is currently undertaken by PHNs which were established in 2015 as commissioning organisations. This was a departure from the role of Medicare Locals, the previous regional primary health organisations which frequently provided services. This paper addresses perceptions of 23 senior staff, 11 board members and 21 members of clinical and community advisory councils or health priority groups from six case study PHNs on the impact of commissioning on equity. Participants view the collection of population health data as facilitating service access through redistributing services on the basis of need and through bringing objectivity to decision-making about services. Conversely, participants question the impact of the political and geographical context and population profile on capacity to improve service access and equity through service commissioning. Service delivery was seen as fragmented, the model is at odds with the manner in which Aboriginal Community Controlled Health Organisations (ACCHOs) operate and rural regions lack services to commission. As a consequence, reliance upon commissioning of services may not be appropriate for the Australian primary healthcare context.
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Affiliation(s)
- Julie Henderson
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Sara Javanparast
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Tamara MacKean
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Fran Baum
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Anna Ziersch
- Southgate Institute for Health, Society, and Equity, Flinders University, Adelaide, South Australia, Australia
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Inghels M, Coffie P, Larmarange J. Recours aux soins de santé globale et de santé sexuelle et reproductive, chez les étudiants de l’université Houphouët-Boigny, Abidjan, Côte d’Ivoire. Rev Epidemiol Sante Publique 2017; 65:369-379. [DOI: 10.1016/j.respe.2017.04.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/23/2016] [Accepted: 04/14/2017] [Indexed: 10/18/2022] Open
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Urbanoski K, Inglis D, Veldhuizen S. Service Use and Unmet Needs for Substance Use and Mental Disorders in Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:551-559. [PMID: 28616935 PMCID: PMC5546670 DOI: 10.1177/0706743717714467] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate patterns and predictors of help seeking and met/unmet needs for mental health care in a national population health survey. METHOD Participants were respondents to the 2012 Canadian Community Health Survey on Mental Health (CCHS-MH; n = 25,133). We used regression to identify the diagnostic and sociodemographic predictors of the use of informal supports, primary care, and specialist care, as well as perceived unmet needs. RESULTS Eleven percent of Canadians reported using professionally led services for mental health or substance use in 2012, while another 9% received informal supports. Two-thirds of people with substance use disorders did not receive any care, and among those who did, informal supports were most common. Seventy-four percent of people with mood/anxiety disorders and 88% of those with co-occurring disorders did access services, most commonly specialist mental health care. Men, older people, members of ethnocultural minorities, those not born in Canada, those with lower education, and those with higher incomes were less likely to receive care. Unmet needs were higher among people with substance use disorders. CONCLUSIONS Gaps in services continue to exist for some potentially vulnerable population subgroups. Policy and practice solutions are needed to address these unmet needs. In particular, the convergence of research pointing to gaps in the availability and accessibility of high-quality services for substance use in Canada demands attention.
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Affiliation(s)
- Karen Urbanoski
- 1 Centre for Addictions Research of British Columbia, Victoria, British Columbia.,2 School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia
| | - Dakota Inglis
- 1 Centre for Addictions Research of British Columbia, Victoria, British Columbia
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McKernan S, Reynolds J, Ingleshwar A, Pooley M, Kuthy R, Damiano P. Transportation Barriers and Use of Dental Services among Medicaid-Insured Adults. JDR Clin Trans Res 2017; 3:101-108. [DOI: 10.1177/2380084417714795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study explores how travel distance and other transportation barriers are associated with dental utilization in a Medicaid expansion population. We analyzed data from the Iowa Dental Wellness Plan (DWP), which provides comprehensive dental benefits for low-income adults aged 19 to 64 y as part of Iowa’s Medicaid expansion. Transportation and geographical characteristics were evaluated as enabling factors within the framework of Andersen’s behavioral model of health services use. In March 2015, a random sample of DWP members ( n = 4,800) was surveyed; adjusted survey response rate was 30% ( n = 1,258).The questionnaire was based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Dental Plan Survey and assessed need for dental care, use of dental services and transportation to visits, and self-perceived oral health status. Respondent and dentist addresses were geocoded and used to calculate distance to the nearest DWP general dentist. A logistic regression model predicting utilization of dental care was developed using variables representing each domain of the behavioral model. Most respondents (57%) reported a dental visit since enrolling. Overall, 11% of respondents reported unmet dental need due to transportation problems. Median distance to the nearest general dentist was 1.5 miles. In the adjusted model, travel distance was not significantly associated with the likelihood of dental utilization. However, other transportation-related issues were significantly associated with utilization, including concern about cost of transportation and driver/passenger status. As concern about transportation cost increased, likelihood of having a dental visit decreased. Targeted approaches to assisting low-income populations with transportation barriers should be considered in designing policies and interventions to improve access to dental care. Knowledge Transfer Statement: The results of this study can be used by policy makers and public health planners when designing programs and interventions to improve access to dental care. Consideration of transportation availability and costs could improve utilization of routine dental care, especially among low-income populations.
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Affiliation(s)
- S.C. McKernan
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
| | - J.C. Reynolds
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
| | - A. Ingleshwar
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
| | - M. Pooley
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
| | - R.A. Kuthy
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
| | - P.C. Damiano
- Department of Preventive & Community Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- University of Iowa Public Policy Center, Iowa City, Iowa, USA
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Hwang J, Guilcher SJT, McIsaac KE, Matheson FI, Glazier R, O'Campo P. An examination of perceived health care availability and unmet health care need in the City of Toronto, Ontario, Canada. Canadian Journal of Public Health 2017; 108:e7-e13. [PMID: 28425893 DOI: 10.17269/cjph.108.5715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/17/2017] [Accepted: 10/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although timely access to health care is a top priority, a burgeoning body of research highlights the important role of neighbourhood environments on unmet health care needs. This study aimed to examine an association between perceptions of neighbourhood availability of health care services and experience of unmet health care needs by gender in an urban city setting. METHODS A total of 2338 participants from the Neighbourhood Effects on Health and Well-being (NEHW) study, between 25 and 64 years of age and dwelling in the City of Toronto, Ontario, Canada, were included in the analyses. Four different logistic regression models stratified by gender were used to examine the relationship between neighbourhood health care availability and unmet health care need as well as the impact of neighbourhood perception of health care availability on the three different types of unmet needs. RESULTS Perceived health care availability was associated with higher likelihood of experiencing unmet health care needs in both women and men (women = OR: 1.58, 95% CI: 1.09-2.28; men = OR: 1.92, 95% CI: 1.23-2.99). In addition, perceived health care availability was associated with barrier- and wait times-related unmet health care need among women (OR: 1.83, 95% CI: 1.13-2.97; OR: 1.93, 95% CI: 1.10-3.40 respectively), and personal choice- and wait times-related unmet need among men (OR: 1.99, 95% CI: 1.10-3.58). CONCLUSION Individuals' perception of health care availability plays a crucial role in the experience of unmet health care needs, suggesting the importance of community-based policy development for improving physical conditions and the social aspect of health care services.
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Affiliation(s)
- Jongnam Hwang
- Department of Health Promotion, Daegu University, Gyeongsan, Korea.
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46
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Unmet healthcare needs in Ireland: Analysis using the EU-SILC survey. Health Policy 2017; 121:434-441. [DOI: 10.1016/j.healthpol.2017.02.009] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/15/2016] [Accepted: 02/06/2017] [Indexed: 11/20/2022]
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Park EH, Park EC, Oh DH, Cho E. The Effect of Stress and Depression on Unmet Medical Needs. ACTA ACUST UNITED AC 2017. [DOI: 10.24304/kjcp.2017.27.1.44] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eun Hee Park
- Korea Health Promotion Foundation, Seoul 04554, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea
| | - Daniel H. Oh
- College of Pharmacy, University of the Pacific, California 95817, United States of America
| | - Eun Cho
- College of Pharmacy, Sookmyung Women’s University, Seoul 04310, Republic of Korea
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Hyshka E, Karekezi K, Tan B, Slater LG, Jahrig J, Wild TC. The role of consumer perspectives in estimating population need for substance use services: a scoping review. BMC Health Serv Res 2017; 17:217. [PMID: 28320378 PMCID: PMC5359989 DOI: 10.1186/s12913-017-2153-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background A growing body of research assesses population need for substance use services. However, the extent to which survey research incorporates expert versus consumer perspectives on service need is unknown. We conducted a large, international review to (1) describe extant research on population need for substance use services, and the extent to which it incorporates expert and consumer perspectives on service need, (2) critically assess methodological and measurement approaches used to study consumer-defined need, and (3) examine the potential for existing research that prioritizes consumer perspectives to inform substance use service system planning. Methods Systematic searches of seven databases identified 1930 peer-reviewed articles addressing population need for substance use services between January 1980 and May 2015. Empirical studies (n = 1887) were categorized according to source(s) of data used to derive population estimates of service need (administrative records, biological samples, qualitative data, and/or quantitative surveys). Quantitative survey studies (n = 1594) were categorized as to whether service need was assessed from an expert and/or consumer perspective; studies employing consumer-defined need measures (n = 217) received further in-depth quantitative coding to describe study designs and measurement strategies. Results Almost all survey studies (96%; n = 1534) used diagnostically-oriented measures derived from an expert perspective to assess service need. Of the small number (14%, n = 217) of survey studies that assessed consumer’s perspectives, most (77%) measured perceived need for generic services (i.e. ‘treatment’), with fewer (42%) examining self-assessed barriers to service use, or informal help-seeking from family and friends (10%). Unstandardized measures were commonly used, and very little research was longitudinal or tested hypotheses. Only one study used a consumer-defined need measure to estimate required service system capacity. Conclusions Rhetorical calls for including consumer perspectives in substance use service system planning are belied by the empirical literature, which is dominated by expert-driven approaches to measuring population need. Studies addressing consumer-defined need for substance use services are conceptually underdeveloped, and exhibit methodological and measurement weaknesses. Further scholarship is needed to integrate multidisciplinary perspectives in this literature, and fully realize the promise of incorporating consumer perspectives into substance use service system planning. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2153-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elaine Hyshka
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada. .,Inner City Health and Wellness Program, B818 Women's Centre, Royal Alexandra Hospital, 10240 Kingsway Avenue, Edmonton, AB, T5H 3VR, Canada.
| | - Kamagaju Karekezi
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Benjamin Tan
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Linda G Slater
- John W. Scott Health Sciences Library, 2 K3.28 Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Jesse Jahrig
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - T Cameron Wild
- School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
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Gargano LM, Thomas PA, Stellman SD. Asthma control in adolescents 10 to 11 y after exposure to the World Trade Center disaster. Pediatr Res 2017; 81:43-50. [PMID: 27656769 PMCID: PMC5235974 DOI: 10.1038/pr.2016.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/02/2016] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about asthma control in adolescents who were exposed to the World Trade Center (WTC) attacks of 11 September 2001 and diagnosed with asthma after 9/11. This report examines asthma and asthma control 10-11 y after 9/11 among exposed adolescents. METHODS The WTC Health Registry adolescent Wave 3 survey (2011-2012) collected data on asthma diagnosed by a physician after 11 September 2001, extent of asthma control based on modified National Asthma Education and Prevention Program criteria, probable mental health conditions, and behavior problems. Parents reported healthcare needs and 9/11-exposures. Logistic regression was used to evaluate associations between asthma and level of asthma control and 9/11-exposure, mental health and behavioral problems, and unmet healthcare needs. RESULTS Poorly/very poorly controlled asthma was significantly associated with a household income of ≤$75,000 (adjusted odds ratio (AOR): 3.0; 95% confidence interval (CI): 1.1-8.8), having unmet healthcare needs (AOR: 6.2; 95% CI: 1.4-27.1), and screening positive for at least one mental health condition (AOR: 5.0; 95% CI: 1.4-17.7), but not with behavioral problems. The impact of having at least one mental health condition on the level of asthma control was substantially greater in females than in males. CONCLUSIONS Comprehensive care of post-9/11 asthma in adolescents should include management of mental health-related comorbidities.
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Affiliation(s)
- Lisa M. Gargano
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Queens, New York,()
| | - Pauline A. Thomas
- Department of Preventive Medicine and Community Health, New Jersey Medical School, Rutgers University, Newark, New Jersey
| | - Steven D. Stellman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Queens, New York,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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Kerätär R, Taanila A, Jokelainen J, Soukainen J, Ala-Mursula L. Work disabilities and unmet needs for health care and rehabilitation among jobseekers: a community-level investigation using multidimensional work ability assessments. Scand J Prim Health Care 2016; 34:343-351. [PMID: 27804309 PMCID: PMC5217281 DOI: 10.1080/02813432.2016.1248632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Comprehensive understanding of the prevalence and quality of work disabilities and unmet needs for health care and rehabilitation to support return to work (RTW) among jobseekers. DESIGN Community-level, cross-sectional analysis with multidimensional clinical work ability assessments. SETTING Paltamo, Finland. PARTICIPANTS Unemployed citizens either participating in the Full-Employment Project or long-term unemployed (n = 230, 81%). MAIN OUTCOME MEASURES Based on data from theme interviews, patient records, supervisors' observations of work performance and clinical examinations, a physician concluded the individual's work ability, categorised into four groups: good work ability, good work ability expected after RTW support, able to transitional work only or unable to work. These groups were cross tabulated with primary diagnoses, types of plans to support RTW, as well as categories of social functioning and motivation, for which sensitivity and specificity scores in detecting work disability were calculated. RESULTS Only about half of the jobseekers had good work ability, 27% were found unable to work in the open labour market and 15% even eligible for a disability pension. For 20%, care or rehabilitation was seen necessary to enable RTW. Poor supervisor- and self-rated performance at work or poor social functioning appeared as sensitive measures in detecting work disability. CONCLUSIONS Work disabilities and unmet needs for health care and rehabilitation are highly prevalent among jobseekers, as depicted using a multidimensional work ability assessment procedure inspired by the International Classification of Functioning (ICF). Further development of work ability assessment practices is clearly needed. KEY POINTS Although the association of unemployment with poor health is well known, evidence on the work ability of the unemployed remains scarce. Work disabilities are common among the unemployed. Multidimensional work ability assessment among the unemployed reveals unmet needs for care and rehabilitation to support return to work. Context sensitivity may add to the accuracy of the doctor's conclusions on work ability.
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Affiliation(s)
- Raija Kerätär
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Outpatient Rehabilitation Clinic, Lapland Healthcare District, Oulu, Finland
- Oorninki Ltd., Oulu, Finland
- CONTACT Raija Kerätär Center for Life Course Health Research, University of Oulu, Susitie 6, 90530 Oulu, Finland
| | - Anja Taanila
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | | | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
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