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Zhang L, Li J, Ma T, Zhang R, Zhang Q. Usual source of care and experiences with primary care among community health service centre patients in Changchun, China: A cross-sectional survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1979-1988. [PMID: 32358993 DOI: 10.1111/hsc.13009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
Under China's healthcare reforms, community health service centres (CHCs) have been established as the preferred primary care providers. Even with this change, there is still little attention paid to patients' usual source of care (USC) from CHCs in Northeastern China. The main purposes of this study were to explore the determinants of usual source of community health service and to examine the association between usual source of community health service and patients' experiences with primary care. A cross-sectional survey with 515 adult patients at CHCs in Jilin Province, China, was conducted between July 2016 and November 2016. The patients' experiences with primary care were assessed with the Primary Care Assessment Tool (PCAT). Patients with self-perceived poor health status (odds ratio = 1.984, 95% confidence interval = 1.145-3.437) and chronic disease (odds ratio = 2.207, 95% confidence interval = 1.203-4.051) were more likely to have a usual source of community health service than patients with self-perceived good health status or without chronic disease. Patients scored the highest on comprehensiveness of services available (Mean = 2.87) and the lowest on community orientation (Mean = 1.83) in all domains of the PCAT, with values ranging from 1 to 4. A multiple linear regression analysis revealed that patients with a usual source of community health service had significantly higher overall scores than those without (B = 0.205, p < .001). This study demonstrated the important role of CHCs in providing affordable health services for patients with chronic disease or poor health status. Moreover, patients who chose a CHC as a USC had better experiences with primary care compared with patients who did not choose a CHC as a USC. However, community-oriented services need to be improved, and efforts to improve patients' experiences should include policies that incentivise patients to adopt a CHC as their USC.
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Affiliation(s)
- Li Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Tianjiao Ma
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Ruijie Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Qian Zhang
- School of Public Health, Jilin University, Changchun, Jilin Province, China
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Griffin-Tomas M, Cahill S, Kapadia F, Halkitis PN. Access to Health Services Among Young Adult Gay Men in New York City. Am J Mens Health 2018; 13:1557988318818683. [PMID: 30569800 PMCID: PMC6775565 DOI: 10.1177/1557988318818683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This research is a cross-sectional study of young adult gay men (YAGM), ages 18 to 29, that aims to understand their health-care access including: having a primary care provider (PCP), frequency of health-care visits, and instances of foregone health care. Surveys were conducted with a modified time-space sample of 800 YAGM in New York City (NYC). Surveys were conducted between November 2015 and June 2016. This study examined associations between sociodemographic characteristics and health-care access using multivariable logistic regression models. In multivariable logistic regression models, there were higher odds of having a PCP among participants enrolled in school (Adjusted Odds Ratio [AOR] = 1.85, 95% CI [1.18, 2.91], p < .01) and covered by insurance (AOR = 21.29, 95% CI [11.77, 38.53], p < .001). Modeling indicated higher odds of more than one health visit in the past 12 months for non-White participants (AOR = 2.27, 95% CI [1.43, 3.63], p < .001), those covered by insurance (AOR = 3.10, 95% CI [1.06, 9.04], p < .05), and those who disclosed their sexual orientation to their PCP (AOR = 2.99, 95% CI [1.58, 5.69], p < .001). Participants with insurance were less likely to report instances of foregone care (AOR = 0.21, 95% CI [0.21, 0.13], p < .001). Understanding the facilitators and barriers to health-care access among YAGM populations is of critical importance, as many YAGM between the ages of 18 and 29 are establishing their access to health care without parental guidance. Health-care access, including the decision to forego care, can represent a missed opportunity for primary prevention and early diagnosis of health issues, as well as more effective, less invasive, and less costly treatments.
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Affiliation(s)
- Marybec Griffin-Tomas
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA
| | - Sean Cahill
- 3 National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA
| | - Farzana Kapadia
- 1 New Jersey City University, Health Sciences Department, Jersey City, NJ, USA.,2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,4 Department of Population Health, Langone Medical Center, New York University, New York, NY, USA
| | - Perry N Halkitis
- 2 Center for Health, Identity, Behavior and Prevention Studies, Rutgers University, Newark, NJ, USA.,5 Department of Biostatistics & Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, NJ, USA.,6 Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.,7 Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA.,8 Department of Urban-Global Public Health, Rutgers School of Public Health, Rutgers University, Newark, NJ, USA
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3
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Ingram EM. A Comparison of Help Seeking Between Latino and Non-Latino Victims of Intimate Partner Violence. Violence Against Women 2016; 13:159-71. [PMID: 17251503 DOI: 10.1177/1077801206296981] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Analyses based on a random-digit-dial survey of households ( N = 12,039) compared Latinos and non-Latinos on sociodemographic factors for intimate partner violence (IPV) and help seeking. Lifetime prevalence of IPV was found to be lower for Latinos than for non-Latinos, but past-year prevalence of IPV was greater for Latinos. Reported IPV victimization was greater among non-Latinos than among Latinos at education levels below college and at family incomes less than $35,000. Informal help seeking was found to be similar for Latinos and non-Latinos; however, non-Latinos reported seeking access to shelters more frequently than Latinos, and Latino immigrants were less likely than non-immigrants to seek help from formal agencies.
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Affiliation(s)
- Eben M Ingram
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Du Z, Liao Y, Chen CC, Hao Y, Hu R. Usual source of care and the quality of primary care: a survey of patients in Guangdong province, China. Int J Equity Health 2015; 14:60. [PMID: 26227113 PMCID: PMC4521373 DOI: 10.1186/s12939-015-0189-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Usual source of care (USC) refers to the provider or place a patient consults when sick or in need of medical advice. No studies have been conducted in China to compare the quality of primary care provided with or without USC. The purpose of this study was to fill this gap in the literature by examining the quality of primary care provided between those having a USC and those without. Results of the study would provide implications for policymakers in terms of improving primary care performance in China, and help guide patients in their health care seeking behaviors. Methods A cross-sectional survey with patients was conducted in Guangdong province of China, using the Chinese validated Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and ten domains of primary care quality for patients with and without USC. Multivariate analyses were used to assess the association between USC and quality of primary care attributes while controlling for sociodemographic and health care characteristics. Results The study added evidence that having a USC can provide higher quality of primary care to patients than those without a USC. Results of this study showed that the PCAT score associated with those having a USC was significantly higher than those not having a USC. Moreover, the study showed that having a usual provider of care was also independently and significantly associated with patients’ satisfaction with care. Conclusions This study added evidence that in China, patients with a USC reported higher quality of medical care experiences compared with those without a USC. The efforts to improve quality of care should include policies promoting USC.
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Affiliation(s)
- Zhicheng Du
- Department of Medical Statistics and Epidemiology, Health Information Research Center, Guangdong Key, Laboratory of Medicine, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, Guangdong Province, 510080, Peoples Republic of China.
| | - Yu Liao
- Department of Medical Statistics and Epidemiology, Health Information Research Center, Guangdong Key, Laboratory of Medicine, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, Guangdong Province, 510080, Peoples Republic of China.
| | - Chien-Chou Chen
- Department of International Business, Ling Tung University, Taichung City, Taiwan, 40852, R.O.C.
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, Health Information Research Center, Guangdong Key, Laboratory of Medicine, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, Guangdong Province, 510080, Peoples Republic of China.
| | - Ruwei Hu
- Department of health management, School of Public Health, Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, Guangdong Province, 510080, Peoples Republic of China.
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Burgard SA, Hawkins JM. Race/Ethnicity, educational attainment, and foregone health care in the United States in the 2007-2009 recession. Am J Public Health 2013; 104:e134-40. [PMID: 24328647 DOI: 10.2105/ajph.2013.301512] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study assessed possible associations between recessions and changes in the magnitude of social disparities in foregone health care, building on previous studies that have linked recessions to lowered health care use. METHODS Data from the 2006 to 2010 waves of the National Health Interview Study were used to examine levels of foregone medical, dental and mental health care and prescribed medications. Differences by race/ethnicity and education were compared before the Great Recession of 2007 to 2009, during the early recession, and later in the recession and in its immediate wake. RESULTS Foregone care rose for working-aged adults overall in the 2 recessionary periods compared with the pre-recession. For multiple types of pre-recession care, foregoing care was more common for African Americans and Hispanics and less common for Asian Americans than for Whites. Less-educated individuals were more likely to forego all types of care pre-recession. Most disparities in foregone care were stable during the recession, though the African American-White gap in foregone medical care increased, as did the Hispanic-White gap and education gap in foregone dental care. CONCLUSIONS Our findings support the fundamental cause hypothesis, as even during a recession in which more advantaged groups may have had unusually high risk of losing financial assets and employer-provided health insurance, they maintained their relative advantage in access to health care. Attention to the macroeconomic context of social disparities in health care use is warranted.
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Affiliation(s)
- Sarah A Burgard
- Sarah A. Burgard is with the Departments of Sociology and Epidemiology, University of Michigan, Ann Arbor. Jaclynn M. Hawkins is with the Departments of Sociology and Social Work, University of Michigan
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Daley AM, Sadler LS, Reynolds HD. Tailoring clinical services to address the unique needs of adolescents from the pregnancy test to parenthood. Curr Probl Pediatr Adolesc Health Care 2013; 43:71-95. [PMID: 23522339 PMCID: PMC3624884 DOI: 10.1016/j.cppeds.2013.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/25/2013] [Indexed: 12/28/2022]
Abstract
Clinicians across disciplines and practice settings are likely to encounter adolescents who are at risk for a pregnancy. In 2010, 34.2/1000 15-19-year-old teens had a live birth in the United States, many more will seek care for a pregnancy scare or options counseling. Teen mothers are also at risk for a second or higher-order pregnancy during adolescence. This paper provides clinicians with adolescent-friendly clinical and counseling strategies for pregnancy prevention, pre- and post-pregnancy test counseling, pregnancy-related care, and a review of the developmental challenges encountered by teens in the transition to parenthood. Clinicians are in a better position to approach the developmental, health and mental health needs of adolescents related to pregnancy if they understand and appreciate the obstacles adolescents may face negotiating the healthcare system. In addition, when clinical services are specially tailored to the needs of the adolescent, fewer opportunities will be lost to prevent unintended pregnancies, assist teens into timely prenatal services, and improve outcomes for their pregnancies and the transition to parenthood.
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Affiliation(s)
- Alison Moriarty Daley
- Yale University School of Nursing, New Haven, CT
- Yale-New Haven Hospital Adolescent Clinic/ Hill Regional Career School-Based Health Center, New Haven, CT
| | - Lois S. Sadler
- Yale University School of Nursing, New Haven, CT
- Yale Child Study Center, New Haven, CT
| | - Heather Dawn Reynolds
- Yale University School of Nursing, New Haven, CT
- Yale-New Haven Hospital Women’s Center, New Haven, CT
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McKee MD, Rubin SE, Campos G, O'Sullivan LF. Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives. Ann Fam Med 2011; 9:37-43. [PMID: 21242559 PMCID: PMC3022043 DOI: 10.1370/afm.1186] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. METHODS We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTS The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.
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Affiliation(s)
- M Diane McKee
- Department of Family and Social Medicine, Montefiore Medical Center, Bronx, NY, USA.
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Usual source of care and the quality of medical care experiences: a cross-sectional survey of patients from a Taiwanese community. Med Care 2010; 48:628-34. [PMID: 20548255 DOI: 10.1097/mlr.0b013e3181dbdf76] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study used a recent patient survey to examine the relationship between having a usual source of care (USC) and the quality of ambulatory medical care experiences in Taiwan, where there is universal health insurance coverage. RESEARCH DESIGN, SUBJECTS, AND MEASURES The study design was a cross-sectional survey of 879 patients in Taichung County, Taiwan. Children and adults visiting hospital-based physicians were included. Quality of care was measured using items from the Primary Care Assessment Tool (PCAT), representing 7 ambulatory medical care domains: first contact (ie, access and utilization), longitudinality (ie, ongoing care), coordination (ie, referrals and information systems), comprehensiveness (ie, services available and provided), family centeredness, community orientation, and cultural competence. USC was defined based on responses to 3 survey items from the PCAT. RESULTS Having a USC was significantly associated with higher quality of medical care experiences. Specifically, having a USC was associated with improved accessibility and utilization, ongoing care, coordination of referrals, and healthcare providers' family centeredness and cultural competence. However, having a USC was not strongly related with comprehensiveness of services, coordination of information systems, or healthcare providers' community orientation. CONCLUSION In a region with universal health insurance, patients with a USC reported higher quality of medical care experiences compared with those without a USC. Beyond the provision of health insurance coverage, efforts to improve quality of care should include policies promoting USC.
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Sarmiento OL, Miller WC, Ford CA, Schoenbach VJ, Adimora AA, Viadro CI, Suchindran CM. Routine physical examination and forgone health care among Latino adolescent immigrants in the United States. J Immigr Minor Health 2009; 7:305-16. [PMID: 19813296 DOI: 10.1007/s10903-005-5128-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Knowledge concerning patterns of health care utilization among Latino-adolescent immigrants is needed to develop culturally-appropriate programs. The objectives of this study were to estimate the annual prevalence of having had a routine physical exam and episodes of adolescents' not seeking health care when they thought they should (forgone health care) among Latino adolescents by immigrant-generational status. Cross-sectional analysis of data from Latino adolescents in Wave I of the National Longitudinal Adolescent Health Study. First-generation immigrants who had lived in the U.S. < or = 5 years were less likely to receive routine care than third-generation immigrants (39.0% vs. 54.9%). This disparity decreased after adjustment for insurance status, parental education and poverty among Mexican origin adolescents. On average, 16.0% of first-generation immigrants who had lived in the U.S. < or = 5 years and 22.5% of third-generation immigrants reported forgoing health care. After adjustment for age, insurance status, parental education and routine care, recent arrivals were less likely than third-generation immigrants to forgo health care. Recent arrivals were less likely to receive a routine physical exam and to forgo care than third-generation immigrants. Future studies should explore the effect of acculturation on knowledge, beliefs and perceptions about health, illness and care-seeking behaviors.
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Affiliation(s)
- Olga L Sarmiento
- Departments of Epidemiology, University of North Carolina at Chapel Hill, NC 27599-7435, USA
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Mielck A, Kiess R, Knesebeck OVD, Stirbu I, Kunst AE. Association between forgone care and household income among the elderly in five Western European countries - analyses based on survey data from the SHARE-study. BMC Health Serv Res 2009; 9:52. [PMID: 19309496 PMCID: PMC2666678 DOI: 10.1186/1472-6963-9-52] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 03/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies on the association between access to health care and household income have rarely included an assessment of 'forgone care', but this indicator could add to our understanding of the inverse care law. We hypothesize that reporting forgone care is more prevalent in low income groups. METHODS The study is based on the 'Survey of Health, Ageing and Retirement in Europe (SHARE)', focusing on the non-institutionalized population aged 50 years or older. Data are included from France, Germany, Greece, Italy and Sweden. The dependent variable is assessed by the following question: During the last twelve months, did you forgo any types of care because of the costs you would have to pay, or because this care was not available or not easily accessible? The main independent variable is household income, adjusted for household size and split into quintiles, calculating the quintile limits for each country separately. Information on age, sex, self assessed health and chronic disease is included as well. Logistic regression models were used for the multivariate analyses. RESULTS The overall level of forgone care differs considerably between the five countries (e.g. about 10 percent in Greece and 6 percent in Sweden). Low income groups report forgone care more often than high income groups. This association can also be found in analyses restricted to the subsample of persons with chronic disease. Associations between forgone care and income are particularly strong in Germany and Greece. Taking the example of Germany, forgone care in the lowest income quintile is 1.98 times (95% CI: 1.08-3.63) as high as in the highest income quintile. CONCLUSION Forgone care should be reduced even if it is not justified by an 'objective' need for health care, as it could be an independent stressor in its own right, and as patient satisfaction is a strong predictor of compliance. These efforts should focus on population groups with particularly high prevalence of forgone care, for example on patients with poor self assessed health, on women, and on low income groups. The inter-country differences point to the need to specify different policy recommendations for different countries.
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Affiliation(s)
- Andreas Mielck
- Helmholtz Zentrum Muenchen – German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, 85758 Neuherberg, Germany
| | - Raphael Kiess
- Helmholtz Zentrum Muenchen – German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, P.O. Box 1129, 85758 Neuherberg, Germany
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Department of Medical Sociology, Martinistr. 52, 20246 Hamburg, Germany
| | - Irina Stirbu
- Erasmus Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anton E Kunst
- Erasmus Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Schaffer SJ, Fontanesi J, Rickert D, Grabenstein JD, Rothholz MC, Wang SA, Fishbein D. How effectively can health care settings beyond the traditional medical home provide vaccines to adolescents? Pediatrics 2008; 121 Suppl 1:S35-45. [PMID: 18174319 DOI: 10.1542/peds.2007-1115e] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our goal was to evaluate the capacity of various health care settings to supplement the activities of the traditional medical home by delivering vaccines to adolescents. METHODS A group of experts in the fields of adolescent-immunization delivery and the provision of preventive care in various health care settings summarized the available literature, considered setting-specific factors, and assessed the ability of various health care settings beyond the traditional medical home to conform to the immunization quality standards set by the National Vaccine Advisory Committee, report vaccination information for the quantitative assessment of vaccine-coverage rates, be likely to offer vaccines to adolescents, and be viewed by adolescents as acceptable sites for receiving vaccinations. RESULTS Seven candidate settings were evaluated: pharmacies, obstetrics-gynecology practices, sexually transmitted disease clinics, hospital emergency departments, family planning clinics, teen clinics, and local public health department immunization clinics. The panel concluded that all could safely provide vaccinations to adolescents but that vaccination efforts at some of the settings could potentially have a markedly greater impact on overall adolescent-immunization rates than could those at other settings. In addition, for adolescent-vaccination services to be practical, candidate settings need to have a clear interest in providing them. Conditional on that, several issues need to be addressed: (1) funding; (2) orienting facilities to provide preventive care services; (3) enhancing access to immunization registries; and (4) clarifying issues related to immunization consent. CONCLUSIONS With supporting health policy, health education, and communication, health care settings beyond the traditional medical home have the potential to effectively augment the vaccination efforts of more traditional settings to deliver vaccines to adolescents. These health care settings may be particularly well suited to reach adolescents who lack access to traditional sources of preventive medical care or receive fragmented medical care.
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Affiliation(s)
- Stanley J Schaffer
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Callahan ST, Hickson GB, Cooper WO. Health care access of Hispanic young adults in the United States. J Adolesc Health 2006; 39:627-33. [PMID: 17046497 DOI: 10.1016/j.jadohealth.2006.04.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/20/2006] [Accepted: 04/20/2006] [Indexed: 11/24/2022]
Abstract
PURPOSE Hispanic persons in the United States experience higher rates of many chronic conditions than non-Hispanic whites. Access to care, especially during young adulthood, may afford opportunities for prevention or early management of these conditions. Given the heterogeneity of the Hispanic population, the specific aims of this study were to assess health insurance coverage and health care access and utilization for different Hispanic subgroups young adults in the U.S. METHODS We analyzed data from 5189 Hispanic and 13,214 white young adults (19-29 years old) completing the National Health Interview Survey (NHIS) from 1999-2002. Health care access/utilization measures included reports of 1) uninsurance, 2) lacking a usual source of care, 3) no health professional contact, and 4) delaying needed care because of cost. Multivariate analyses were used to estimate the risk of access barriers after adjusting for sociodemographic variables and citizenship. RESULTS Young adults of Central/South American, Mexican, or Puerto Rican origins were more likely than whites to be uninsured (28%-64% vs. 22%; p < .01) and this was especially true for noncitizens. Central/South American and Mexican young adults without U.S. citizenship were most likely to be uninsured (63% and 73%, respectively). The majority of noncitizens also lacked a usual source of care and had no health professional contact in the prior year. After adjustment, the risk of uninsurance was 60% higher for Mexican and Central/South American young adults relative to white peers. Mexican young adults also had higher risk of lacking a usual source of care and having no health professional contact. CONCLUSIONS Substantial variability in rates of uninsurance and health care access/utilization measures exist among subgroups of Hispanic young adults participating in the NHIS. U.S. citizenship and sociodemographic factors explain much, but not all of the differences.
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Affiliation(s)
- S Todd Callahan
- Child and Adolescent Health Research Unit, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee 37212-3100, USA.
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Fonseca H, Ireland M, Resnick MD. Familial correlates of extreme weight control behaviors among adolescents. Int J Eat Disord 2002; 32:441-8. [PMID: 12386908 DOI: 10.1002/eat.10078] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify familial factors associated with extreme weight control among adolescents. METHOD Analysis of a comprehensive 1996 health survey of Connecticut students. Familial factors among extreme dieters who deliberately vomited, took diet pills, laxatives, or diuretics were compared with youth reporting none of these behaviors, using logistic regression controlling for age and body mass index. RESULTS Nearly 7% of adolescents reported engaging in extreme weight control behaviors. Boys' risk factors included high parental supervision/monitoring and sexual abuse history. Protective factors included high parental expectations, maternal presence, and connectedness with friends and other adults. The only significant risk factor for girls was sexual abuse history. Protective factors included family connectedness, positive family communication, parental supervision/monitoring, and maternal presence. CONCLUSIONS Extreme dieting appears to be less an expression of body composition than of psychosocial issues. That connectedness to family, other adults, and friends is protective further demonstrates interrelationships of extreme weight control behaviors with family/social issues.
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Affiliation(s)
- Helena Fonseca
- Adolescent Health Outpatient Clinic, Pediatric Division, Hospital de Santa Maria, Lisboa, Portugal
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Yu SM, Bellamy HA, Schwalberg RH, Drum MA. Factors associated with use of preventive dental and health services among U.S. adolescents. J Adolesc Health 2001; 29:395-405. [PMID: 11728889 DOI: 10.1016/s1054-139x(01)00252-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE To examine adolescents' use of preventive medical and dental services and its relationship to demographic characteristics and other variables reflecting access to and need for care. METHODS Self- and parent-reported data from a sample of 5644 adolescents aged 11 to 21 years from the National Longitudinal Study of Adolescent Health (Add Health). Variables studied include the influence of both the adolescents' demographic and socioeconomic characteristics (age, race/ethnicity, place of birth, acculturation, insurance status, and perception of health), as well as those of their parents (race/ethnicity, income, level of education, place of birth) on their lifetime use and use within the past year of medical and dental services. Bivariate and logistic regression analyses were conducted using SAS and SUDAAN. RESULTS Approximately 32% of respondents had not had a physical examination in the year before the survey, and the same percentage had not had a dental examination. Approximately 2% reported never having had either a physical or a dental examination. Logistic regression reveals that lack of insurance, low family income, and low parental education level are significantly associated with the lack of preventive medical care. Lack of an annual dental visit was associated with male gender; black, Hispanic, or mixed race/ethnicity; and lack of insurance. Never having had a dental visit was the only dependent variable found to be associated with place of birth. CONCLUSIONS Health insurance and family income are most consistently related to adolescents' use of preventive medical and dental care. However, the relationship between lack of dental care and place of birth emphasizes the need to improve access to dental services for immigrant teens. These findings are particularly relevant as states design systems of care for adolescents under the State Children's Health Insurance Program.
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Affiliation(s)
- S M Yu
- Maternal and Child Health Bureau, Office of Data and Information Management, Rockville, Maryland 20857, USA
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