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Desravines N, Hazimeh D, Desjardins MR, Wethington SL. Healthcare utilization in women diagnosed with endometrial cancer: A survey-based study. Gynecol Oncol 2024; 186:1-8. [PMID: 38554624 DOI: 10.1016/j.ygyno.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Despite similar incidence, non-Hispanic Black women are twice as likely to die of endometrial cancer as non-Hispanic White women. The social determinants of health may contribute to this disparity. We studied barriers to care and social needs of endometrial cancer patients. METHODS In a cohort of patients with endometrial cancer from the All of Us study, participants self-reported demographics and completed validated surveys (access to medical care, transportation, caregiving, finances, medication, general care, specialty care, housing insecurity). Univariate and multivariate logistic regression models evaluated demographic and access factors associated with any need. RESULTS Of 568 participants, 77.7% identified as non-Hispanic White, 7.5% Black, and 8.8% Hispanic. 59% were > 65 years and 95.8% insured. Contributors to delays in care were paying out of pocket (9.9%), provider anxiety (7.6%), transportation (6.3%), cost of copay (6.2%), and insufficient leave from work (5.6%). To mitigate healthcare costs, 16.2% of participants inquired about lower-cost medications, 11.1% reported delaying filling prescriptions, 7.6% taking fewer prescribed medications, and 6.5% skipped doses. Regarding multivariate analysis, participants earning <$25,000 had a 7.3 (95% CI 1.7-31.7) higher adjusted odds of transportation needs and 3.6 (95% CI 1.4-9.7) higher difficulty accessing specialists. No racial/ethnic disparities were identified. CONCLUSIONS Social needs and barriers to care are most pronounced among endometrial cancer survivors earning <$25,000. Unexpectedly, and possibly related to sample size or survey tool, race/ethnicity were not zassociated with barriers to care. Further studies on health-related social needs, optimal screening tools, and effective interventions are needed in order to achieve equity in cancer outcomes for endometrial cancer patients.
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Affiliation(s)
- Nerlyne Desravines
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States of America
| | - Dana Hazimeh
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States of America
| | - Michael R Desjardins
- Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Stephanie L Wethington
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, United States of America.
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Kazi S, Starling C, Milicia A, Buckley B, Grisham R, Gruber E, Miller K, Arem H. Barriers and facilitators to screen for and address social needs in primary care practices in Maryland: a qualitative study. FRONTIERS IN HEALTH SERVICES 2024; 4:1380589. [PMID: 38952646 PMCID: PMC11215188 DOI: 10.3389/frhs.2024.1380589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/21/2024] [Indexed: 07/03/2024]
Abstract
Background Social needs screening can help modify care delivery to meet patient needs and address non-medical barriers to optimal health. However, there is a need to understand how factors that exist at multiple levels of the healthcare ecosystem influence the collection of these data in primary care settings. Methods We conducted 20 semi-structured interviews involving healthcare providers and primary care clinic staff who represented 16 primary care practices. Interviews focused on barriers and facilitators to awareness of and assistance for patients' social needs in primary care settings in Maryland. The interviews were coded to abstract themes highlighting barriers and facilitators to conducting social needs screening. The themes were organized through an inductive approach using the socio-ecological model delineating individual-, clinic-, and system-level barriers and facilitators to identifying and addressing patients' social needs. Results We identified several individual barriers to awareness, including patient stigma about verbalizing social needs, provider frustration at eliciting needs they were unable to address, and provider unfamiliarity with community-based resources to address social needs. Clinic-level barriers to awareness included limited appointment times and connecting patients to appropriate community-based organizations. System-level barriers to awareness included navigating documentation challenges on the electronic health record. Conclusions Overcoming barriers to effective screening for social needs in primary care requires not only practice- and provider-level process change but also an alignment of community resources and advocacy of policies to redistribute community assets to address social needs.
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Affiliation(s)
- Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Claire Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
| | - Bryan Buckley
- National Committee for Quality Assurance, Washington, DC, United States
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, United States
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Albin JL, Thomas OW, Marvasti FF, Reilly JM. There and Back Again: A Forty-Year Perspective on Physician Nutrition Education. Adv Nutr 2024; 15:100230. [PMID: 38705195 PMCID: PMC11251405 DOI: 10.1016/j.advnut.2024.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 05/07/2024] Open
Abstract
Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report "Nutrition Education in the United States Medical Schools," little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.
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Affiliation(s)
- Jaclyn Lewis Albin
- Departments of Internal Medicine and Pediatrics, the University of Texas Southwestern Medical Center, Dallas, TX, United States.
| | | | - Farshad Fani Marvasti
- Department of Family, Community, and Preventive Medicine, University of Arizona College of Medicine-Phoenix and School of Nutritional Sciences and Wellness, College of Agricultural, Life and Environmental Sciences, University of Arizona, Tucson, AZ, United States
| | - Jo Marie Reilly
- Clinical Family Medicine and Population and Public Health, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
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Zinga J, van der Pligt P, McKay FH. Views and preferences of food-insecure pregnant women regarding food insecurity screening and support within routine antenatal care. Health Expect 2024; 27:e13956. [PMID: 39102650 PMCID: PMC10771804 DOI: 10.1111/hex.13956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/14/2023] [Accepted: 12/16/2023] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Food insecurity is a public health concern that has profound impact on physical and mental health, and on social well-being. Pregnancy is a period in which food insecurity is likely to be particularly deleterious, due to the serious impact on both mother and child. Food insecurity is not routinely screened in antenatal healthcare settings, and the preferences of pregnant women regarding food insecurity screening and support are poorly understood. This study aimed to determine the views and preferences of food-insecure pregnant women regarding food insecurity screening and support within antenatal healthcare. METHODS This qualitative descriptive study used face-to-face semi-structured interviews, conducted in February and March 2023, to gain the views of purposively sampled food-insecure, pregnant women in Melbourne, Australia. Food insecurity was evidenced by an affirmative response to at least one of three assessment items in a screening questionnaire. Qualitative content analysis was conducted to summarise the views and preferences of women. RESULTS Nineteen food-insecure pregnant women were interviewed. Three themes were identified: (1) acceptability of being screened for food insecurity, (2) concerns about the consequences of disclosure and (3) preferences regarding food insecurity screening and supportive strategies that could be offered within an antenatal healthcare setting. CONCLUSION Women were accepting of food insecurity screening being conducted within routine healthcare. Women identified potential benefits of routine screening, such as feeling supported by their clinician to have a healthy pregnancy and less pressure to voluntarily ask for food assistance. Women gave suggestions for the implementation of food insecurity screening to optimise their healthcare experience, maintain their dignity and feel able to disclose within a safe and caring environment. These results indicate that food insecurity screening in the antenatal setting is likely to have support from pregnant women and is urgently needed in the interest of promoting optimal nutrition for women and children. PATIENT CONTRIBUTION Pregnant women with lived experience of food insecurity were purposively sampled to obtain their insights regarding screening and support within a pregnancy healthcare setting. Member-checking occurred following data collection, whereby all participants were offered the opportunity to review their interview transcript to ensure trustworthiness of the data.
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Affiliation(s)
- Julia Zinga
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsRoyal Women's HospitalParkvilleVictoriaAustralia
| | - Paige van der Pligt
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN)Deakin UniversityGeelongVictoriaAustralia
- Department of Nutrition and DieteticsWestern HealthFootscrayVictoriaAustralia
| | - Fiona H. McKay
- School of Health and Social Development, Institute for Health Transformation, Faculty of HealthDeakin UniversityMelbourneVictoriaAustralia
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Garcia C, Doran K, Kushel M. Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations. Health Aff (Millwood) 2024; 43:164-171. [PMID: 38315930 DOI: 10.1377/hlthaff.2023.01049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs. Initiatives using the Housing First approach to permanent supportive housing have a strong track record of success. Health care financing innovations using Medicaid Section 1115 waivers offer promising new approaches to improving health and housing for people experiencing homelessness. To substantially reduce homelessness and its many adverse health impacts, changes are needed to increase the supply of affordable housing for households with very low incomes. Health care providers and systems should leverage their political power to advocate for policies that scale durable, evidence-based solutions to reduce homelessness, including increased funding to expand housing choice vouchers and greater investment in the creation and preservation of affordable housing.
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Affiliation(s)
- Cheyenne Garcia
- Cheyenne Garcia, University of California San Francisco, San Francisco, California
| | - Kelly Doran
- Kelly Doran, New York University, New York, New York
| | - Margot Kushel
- Margot Kushel , University of California San Francisco
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De Prophetis E, Beck K, Ridgeway D, Chuang J, Richard L, Durbin A, Mazereeuw M, Hynes G, Denny K. Trends in hospital coding for people experiencing homelessness in Canada, 2015-2020: a descriptive study. CMAJ Open 2023; 11:E1188-E1196. [PMID: 38114261 PMCID: PMC10743647 DOI: 10.9778/cmajo.20230044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND In 2018, hospitals were mandated to record homelessness using International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada (ICD-10-CA code Z59.0). We sought to answer whether the coding mandate affected the volume of patients identified as experiencing homelessness in acute inpatient hospitalizations and if there was any geographic variation. METHODS We conducted a serial cross-sectional study describing 6 fiscal years (2015/16 to 2020/21) of hospital administrative data from the Hospital Morbidity Database. We reported frequencies and percentages of hospitalizations with a Z59.0 diagnostic code and disaggregated by several types of Canadian geographies. Controlling for fiscal quarter (coded Q1 to Q4) and province or territory, adjusted logistic regression models quantified the odds of Z59.0 being coded during hospital stays. RESULTS The frequency and percentage of people experiencing homelessness in hospitalization records across Canada increased from 6934 (0.12%) in 2015/16 to 21 529 (0.41%) in 2020/21. Trends varied by province and territory. Recording of the Z59.0 code increased following the mandate (adjusted odds ratio 2.29, 95% confidence interval 2.25-2.32), relative to the pre-mandate period. INTERPRETATION The 2018 coding mandate coincided with an increase in the use of the Z59.0 code to document homelessness in health care administrative data; however, trends varied by jurisdiction. The ICD-10-CA code Z59.0 presents a promising opportunity for standardized and routinely collected data to identify people experiencing homelessness in hospital administrative data.
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Affiliation(s)
- Eric De Prophetis
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont.
| | - Kinsey Beck
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Diana Ridgeway
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Junior Chuang
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Lucie Richard
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Anna Durbin
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Maegan Mazereeuw
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Geoff Hynes
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
| | - Keith Denny
- Canadian Institute for Health Information (De Prophetis, Beck, Ridgeway, Chuang, Mazereeuw, Hynes, Denny), Ottawa, Ont.; MAP Centre for Urban Health Solutions (Richard, Durbin), Unity Health Toronto, Toronto, Ont
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