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Li M, Ao Y, Deng S, Peng P, Chen S, Wang T, Martek I, Bahmani H. A Scoping Literature Review of Rural Institutional Elder Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191610319. [PMID: 36011954 PMCID: PMC9408389 DOI: 10.3390/ijerph191610319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 05/31/2023]
Abstract
Under circumstances of pervasive global aging combined with weakened traditional family elder care, an incremental demand for institutional elder care is generated. This has led to a surge in research regarding institutional elder care. Rural residents' institutional elder care is receiving more attention as a major theme in social sciences and humanities research. Based on 94 articles related to rural institutional elder care, this study identified the most influential articles, journals and countries in rural institutional elder care research since 1995. This was done using science mapping methods through a three-step workflow consisting of bibliometric retrieval, scoping analysis and qualitative discussion. Keywords revealed five research mainstreams in this field: (1) the cognition and mental state of aged populations, (2) the nursing quality and service supply of aged care institutions, (3) the aged care management systems' establishment and improvements, (4) the risk factors of admission and discharge of aged care institutions, and (5) deathbed matters regarding the aged population. A qualitative discussion is also provided for 39 urban and rural comparative research papers and 55 pure rural research papers, summarizing the current research progress status regarding institutional elder care systems in rural areas. Gaps within existing research are also identified to indicate future research trends (such as the multi-dimensional and in-depth comparative research on institutional elder care, new rural institutional elder care model and technology, and correlative policy planning and development), which provides a multi-disciplinary guide for future research.
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Affiliation(s)
- Mingyang Li
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
| | - Yibin Ao
- College of Management Science, Chengdu University of Technology, Chengdu 610059, China
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shulin Deng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Panyu Peng
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
| | - Shuangzhou Chen
- Department of Social Work and Social Administration, Faculty of Social Sciences, The University of Hong Kong, Hong Kong, China
| | - Tong Wang
- Faculty of Architecture and Built Environment, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Igor Martek
- School of Architecture and Built Environment, Deakin University, Geelong 3220, Australia
| | - Homa Bahmani
- College of Environment and Civil Engineering, Chengdu University of Technology, Chengdu 610059, China
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Greteman BB, Garcia-Auguste CJ, Gryzlak BM, Kahl AR, Lutgendorf SK, Chrischilles EA, Charlton ME. Rural and urban differences in perceptions, behaviors, and health care disruptions during the COVID-19 pandemic. J Rural Health 2022; 38:932-944. [PMID: 35466479 PMCID: PMC9115219 DOI: 10.1111/jrh.12667] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose The objective of this study was to assess perceptions, health behaviors, and disruptions related to the COVID‐19 pandemic in a largely rural, Midwestern state, and to examine differences between rural and urban respondents. Methods A questionnaire was mailed August 2020 to a sample of 10,009 registered voters in Iowa ages 18‐100 years, with oversampling from 6 select rural counties. Previously validated and tested items assessed COVID‐19 precautions, health care disruptions, emotional reactions, health behavior changes, telehealth and experiences with the internet, and demographic characteristics. Findings There were 4,048 respondents (40% response rate); 65% were rural and 35% were urban residents. The average age of respondents was 58.3 years and 45% of respondents identified as female. Rural respondents reported less concern about COVID‐19 in their community (29% vs 40%, P<.001) and lower perceived importance of social distancing (51% vs 64%, P<.001). Urban respondents more often reported experiencing disruption to daily living, stronger negative emotional reactions, and displayed more pronounced behavior change compared to their rural counterparts. For example, urban respondents reported more pandemic‐related job losses (6% vs 4%, P = .05), disruptions to daily activities (48% vs 35%, P<.001), and use of telehealth services during the pandemic (24% vs 16%, P<.001). Conclusions The majority of respondents reported disruptions to normal activities, medical appointment cancellations, and emotional distress during the first 6 months of the pandemic. The impact of the pandemic on urban residents appeared to be greater than for rural respondents. Timing of pandemic spread and varying beliefs are potential explanations.
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Affiliation(s)
- Breanna B Greteman
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | | | - Brian M Gryzlak
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Susan K Lutgendorf
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | | | - Mary E Charlton
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
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Filteau C, Simeone A, Ravot C, Dayde D, Falandry C. Cultural and Ethical Barriers to Cancer Treatment in Nursing Homes and Educational Strategies: A Scoping Review. Cancers (Basel) 2021; 13:3514. [PMID: 34298728 PMCID: PMC8305927 DOI: 10.3390/cancers13143514] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 06/30/2021] [Accepted: 07/05/2021] [Indexed: 01/15/2023] Open
Abstract
(1) Background: The aging of the population, the increase in the incidence of cancer with age, and effective chronic oncological treatments all lead to an increased prevalence of cancer in nursing homes. The aim of the present study was to map the cultural and ethical barriers associated with the treatment of cancer and educational strategies in this setting. (2) Methods: A systematic scoping review was conducted until April 2021 in MEDLINE, Embase, and CINAHL. All articles assessing continuum of care, paramedical education, and continuing education in the context of older cancer patients in nursing homes were reviewed. (3) Results: A total of 666 articles were analyzed, of which 65 studies were included. Many factors interfering with the decision to investigate and treat, leading to late- or unstaged disease, palliative-oriented care instead of curative, and a higher risk of unjustified transfers to acute care settings, were identified. The educational strategies explored in this context were generally based on training programs. (4) Conclusions: These results will allow the co-construction of educational tools intended to develop knowledge and skills to improve diagnostic and therapeutic decision-making, the consistency of care, and, ultimately, the quality of life of older cancer patients in nursing homes.
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Affiliation(s)
- Cynthia Filteau
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Département de Gériatrie, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC H1T 2M4, Canada
| | - Arnaud Simeone
- Université Lumière-Groupe de Recherche en Psychologie Sociale (UR GRePS) Institut de Psychologie, 69676 Bron, France;
| | - Christine Ravot
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
| | - David Dayde
- Plateforme de Recherche de l’Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France;
| | - Claire Falandry
- Service de Gériatrie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69495 Pierre-Bénite, France; (C.R.); (C.F.)
- Laboratoire CarMeN, INSERM, INRAE, Université Claude Bernard Lyon-1, 69600 Oullins, France
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4
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Zahnd WE, Askelson N, Vanderpool RC, Stradtman L, Edward J, Farris PE, Petermann V, Eberth JM. Challenges of using nationally representative, population-based surveys to assess rural cancer disparities. Prev Med 2019; 129S:105812. [PMID: 31422226 PMCID: PMC7289622 DOI: 10.1016/j.ypmed.2019.105812] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/08/2019] [Accepted: 08/14/2019] [Indexed: 12/16/2022]
Abstract
Population-based surveys provide important information about cancer-related health behaviors across the cancer care continuum, from prevention to survivorship, to inform cancer control efforts. These surveys can illuminate cancer disparities among specific populations, including rural communities. However, due to small rural sample sizes, varying sampling methods, and/or other study design or analytical concerns, there are challenges in using population-based surveys for rural cancer control research and practice. Our objective is three-fold. First, we examined the characterization of "rural" in four, population-based surveys commonly referenced in the literature: 1) Health Information National Trends Survey (HINTS); 2) National Health Interview Survey (NHIS); 3) Behavioral Risk Factor Surveillance System (BRFSS); and 4) Medical Expenditures Panel Survey (MEPS). Second, we identified and described the challenges of using these surveys in rural cancer studies. Third, we proposed solutions to address these challenges. We found that these surveys varied in use of rural-urban classifications, sampling methodology, and available cancer-related variables. Further, we found that accessibility of these data to non-federal researchers has changed over time. Survey data have become restricted based on small numbers (i.e., BRFSS) and have made rural-urban measures only available for analysis at Research Data Centers (i.e., NHIS and MEPS). Additionally, studies that used these surveys reported varying proportions of rural participants with noted limitations in sufficient representation of rural minorities and/or cancer survivors. In order to mitigate these challenges, we propose two solutions: 1) make rural-urban measures more accessible to non-federal researchers and 2) implement sampling approaches to oversample rural populations.
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Affiliation(s)
- Whitney E Zahnd
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America.
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N. Riverside Drive, Iowa City, IA 52242, United States of America.
| | - Robin C Vanderpool
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Lindsay Stradtman
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 111 Washington Avenue, Lexington, KY 40536, United States of America.
| | - Jean Edward
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536, United States of America.
| | - Paige E Farris
- OHSU-PSU School of Public Health, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
| | - Victoria Petermann
- School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall Campus Box #7460, Chapel Hill, NC 27599-7460, United States of America.
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Dr. Suite 204, Columbia, SC 29210, United States of America; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America; Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC 29208, United States of America.
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Jorgensen TSH, Torp-Pedersen C, Gislason GH, Andersson C, Holm E. Time trend in Alzheimer diagnoses and the association between distance to an Alzheimer clinic and Alzheimer diagnosis. Eur J Public Health 2014; 25:522-7. [DOI: 10.1093/eurpub/cku118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Radcliff TA, Bobroff LB, Lutes LD, Durning PE, Daniels MJ, Limacher MC, Janicke DM, Martin AD, Perri MG. Comparing Costs of Telephone vs Face-to-Face Extended-Care Programs for the Management of Obesity in Rural Settings. J Acad Nutr Diet 2012; 112:1363-1373. [PMID: 22818246 PMCID: PMC3432696 DOI: 10.1016/j.jand.2012.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Accepted: 04/24/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND A major challenge after successful weight loss is continuing the behaviors required for long-term weight maintenance. This challenge can be exacerbated in rural areas with limited local support resources. OBJECTIVE This study describes and compares program costs and cost effectiveness for 12-month extended-care lifestyle maintenance programs after an initial 6-month weight-loss program. DESIGN We conducted a 1-year prospective randomized controlled clinical trial. PARTICIPANTS/SETTING The study included 215 female participants age 50 years or older from rural areas who completed an initial 6-month lifestyle program for weight loss. The study was conducted from June 1, 2003 to May 31, 2007. INTERVENTION The intervention was delivered through local Cooperative Extension Service offices in rural Florida. Participants were randomly assigned to a 12-month extended-care program using either individual telephone counseling (n=67), group face-to-face counseling (n=74), or a mail/control group (n=74). MAIN OUTCOME MEASURES Program delivery costs, weight loss, and self-reported health status were directly assessed through questionnaires and program activity logs. Costs were estimated across a range of enrollment sizes to allow inferences beyond the study sample. STATISTICAL ANALYSES PERFORMED Nonparametric and parametric tests of differences across groups for program outcomes were combined with direct program cost estimates and expected value calculations to determine which scales of operation favored alternative formats for lifestyle maintenance. RESULTS Median weight regain during the intervention year was 1.7 kg for participants in the face-to-face format, 2.1 kg for the telephone format, and 3.1 kg for the mail/control format. For a typical group size of 13 participants, the face-to-face format had higher fixed costs, which translated into higher overall program costs ($420 per participant) when compared with individual telephone counseling ($268 per participant) and control ($226 per participant) programs. Although the net weight lost after the 12-month maintenance program was higher for the face-to-face and telephone programs compared with the control group, the average cost per expected kilogram of weight lost was higher for the face-to-face program ($47/kg) compared with the other two programs (approximately $33/kg for telephone and control). CONCLUSIONS Both the scale of operations and local demand for programs are important considerations in selecting a delivery format for lifestyle maintenance. In this study, the telephone format had a lower cost but similar outcomes compared with the face-to-face format.
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Affiliation(s)
- Tiffany A. Radcliff
- Department of Family Medicine, University of Colorado Denver, Mail Stop F413, P.O. Box 6508, Aurora, CO 80045-0508 (during study and present); Department of Health Policy and Management, Texas A&M Health Science Center, School of Rural Public Health, MS 1266, College Station, TX 77843-1266. (present) , tel. 979-862-7821, fax: 979-458-0656
| | - Linda B. Bobroff
- Department of Food and Nutrition, IFAS, University of Florida, 3026-B McCarty Hall D PO BOX 110310, Gainesville, FL 32611-0310 , tel. 352-273-3521 fax: 352-392-8196
| | - Lesley D. Lutes
- Department of Psychology, East Carolina University, 104 Rawl Building, Greenville, NC 27858-4353 , tel. 252-328-6283
| | - Patricia E. Durning
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 10065, Gainesvillve, FL 32610 , tel. 352-273-6037, fax: 352-273-6199
| | - Michael J. Daniels
- Department of Statistics, 102 Griffin-Floyd Hall, P.O. Box 118545 Gainesville, FL 32611-8545, , tel. 352-273-1845, fax: 352-392-5175
| | - Marian C. Limacher
- Division of Cardiiovascular Medicine, School of Medicine, University of Florida, PO Box 100277, Room M-409 Gainesville, FL 32611-0277, , tel.: 352-846-1228, fax: 352-846-1217
| | - David M. Janicke
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, P.O. Box 10065, Gainesvillve, FL 32610 , tel. 352-273-6046, fax: (352) 273-6156
| | - A. Daniel Martin
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, P.O. Box 100154, Gainesville, FL 32610 , tel. 352-273-6105, fax: 352-273-6109
| | - Michael G. Perri
- University of Florida, College of Public Health and Health Professions, 101 S. Newell Drive, Suite 4101, Gainesvillve, FL 32610 , tel. 352-273-6214, fax: 352-273-6199
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7
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Lane AM. Placement of Older Adults from Hospital Mental Health Units into Nursing Homes. J Gerontol Nurs 2011; 37:49-55. [DOI: 10.3928/00989134-20100730-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 04/06/2010] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Understanding the prevalence, incidence and cofactors of depression among long-term elderly nursing home (LTNH) residents domiciled for eight months or more may help optimize depression treatment in this vulnerable group. We quantified first year depression in American LTNH residents and the associations between depression and resident/facility characteristics. METHODS Data were obtained from the Minimum Data Set and Online Survey Certification and Reporting for 634,060 LTNH residents admitted from 1999 to 2005 in 4,216 facilities. Depression first diagnosed at admission and at subsequent quarterly intervals through the first year of stay was examined. Logistic regressions modeled correlates of newly identified depression in each time-period. RESULTS Recorded depression at admission and during the first year increased from 1999 to 2005. By 2005, 54.4% of LTNH residents had depression diagnosed over the first year; 32.8% at admission and a further 21.6% later during the first year. Antidepressant use was reported prior to depression diagnosis for 48% of those first identified depressed after admission. Men, non-Hispanic blacks, never married, and severely-cognitively impaired LTNH residents were less often identified with depression, particularly at admission. Pain and physical comorbidity were positively associated with depression identified throughout the first year. Prior institutionalization was associated with depression at admission, but not new depression after admission. Facility characteristics had weaker associations with depression. CONCLUSIONS High depression rates at admission and during the first year indicate a need to monitor and treat large numbers of American LTNH residents for depression. Reduced associations between demographics and depression as stays progress suggest other factors have increased roles in depression etiology.
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Rabinowitz T, Murphy KM, Amour JL, Ricci MA, Caputo MP, Newhouse PA. Benefits of a telepsychiatry consultation service for rural nursing home residents. Telemed J E Health 2010; 16:34-40. [PMID: 20070161 DOI: 10.1089/tmj.2009.0088] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Psychiatric care for nursing home residents is difficult to obtain, especially in rural areas, and this deficiency may lead to significant morbidity or death. Providing this service by videoconference may be a helpful, cost-effective, and acceptable alternative to face-to-face treatment. We analyzed data for 278 telepsychiatry encounters for 106 nursing home residents to estimate potential cost and time savings associated with this modality compared to in-person care. A total of 843.5 hours (105.4 8-hour work days) of travel time was saved compared to in-person consultation for each of the 278 encounters if they had occurred separately. If four resident visits were possible for each trip, the time saved would decrease to 26.4 workdays. Travel distance saved was 43,000 miles; 10,750 miles if four visits per trip occurred. More than $3,700 would be spent on gasoline for 278 separate encounters; decreased to $925 for four visits per roundtrip. Personnel cost savings estimates ranged from $33,739 to $67,477. Physician costs associated with additional travel time ranged from $84,347 to $253,040 for 278 encounters, or from $21,087 to $63,260 for four encounters per visit. The telepsychiatry approach was enthusiastically accepted by virtually all residents, family members, and nursing home personnel, and led to successful patient management. Providing psychiatric care to rural nursing home residents by videoconference is cost effective and appears to be a medically acceptable alternative to face-to-face care. In addition, this approach will allow many nursing homes to provide essential care that would not otherwise be available.
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Affiliation(s)
- Terry Rabinowitz
- Department of Psychiatry, University of Vermont College of Medicine and Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
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Grabowski DC, Aschbrenner KA, Rome VF, Bartels SJ. Quality of mental health care for nursing home residents: a literature review. Med Care Res Rev 2010; 67:627-56. [PMID: 20223943 DOI: 10.1177/1077558710362538] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors.
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Affiliation(s)
- David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, MA 02115-5899, USA.
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Lane A, McCoy L, Ewashen C. The textual organization of placement into long-term care: issues for older adults with mental illness. Nurs Inq 2010; 17:2-14. [DOI: 10.1111/j.1440-1800.2009.00470.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Raehl C, Maclaughlin E, Patry R, Leeper S, Bond CA. Early implementation of medicare part D in urban and rural nursing facilities. ACTA ACUST UNITED AC 2008; 22:744-53. [PMID: 18198969 DOI: 10.4140/tcp.n.2007.744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine if differences occurred in the early implementation of Medicare Part D (prescription drug program) between urban and rural nursing facilities. DESIGN Nursing facility demographic data, obtained from the Nursing Facility Compare Medicare Web site, were used to create matched pairs of rural and urban facilities. On-site interviews were conducted in June and July 2006 with one designated representative from each nursing facility. Details for each prescription drug plan (PDP), identified by the facility representatives, were obtained from the PDP's Web site. SETTING A prospective pilot field study of rural and urban nursing facilities was created from among 40 facilities in the 26-county Texas Panhandle. Five rural/urban nursing facilities of identical ownership and of similar perceived quality (number of cited deficiencies) and staffing (total nursing staff time per resident) were used for the pilot study. PARTICIPANTS Nursing facility employees charged with overseeing Part D implementation and trained interviewers. INTERVENTION None. MAIN OUTCOME MEASURES Number of PDPs per nursing facility and distribution of persons providing enrollment decision support. RESULTS Rural facilities used more PDPs (7.4 +/- 3.9) than did urban facilities (4.6 +/- 3.8, NSS). Independent samples Student's t-test determined that there was a significant difference in the average number of drugs per resident. Rural residents received fewer medications (8.2 +/- 1.9) than urban residents (11.2 +/- 2.2; P = 0.049, t = 2.32). CONCLUSIONS These early findings suggest that rural nursing facilities interact with more PDPs than urban facilities and that Medicare Part D enrollment decisions are more likely to be aided by family members in rural facilities than in urban nursing facilities.
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Affiliation(s)
- Cynthia Raehl
- Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX 79106-1712, USA.
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Cepoiu M, McCusker J, Cole MG, Sewitch M, Belzile E, Ciampi A. Recognition of depression by non-psychiatric physicians--a systematic literature review and meta-analysis. J Gen Intern Med 2008; 23:25-36. [PMID: 17968628 PMCID: PMC2173927 DOI: 10.1007/s11606-007-0428-5] [Citation(s) in RCA: 256] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2007] [Revised: 09/29/2007] [Accepted: 10/04/2007] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression, with up to 11.9% prevalence in the general population, is a common disorder strongly associated with increased morbidity. The accuracy of non-psychiatric physicians in recognizing depression may influence the outcome of the illness, as unrecognized patients are not offered treatment for depression. OBJECTIVES To describe and quantitatively summarize the existing data on recognition of depression by non-psychiatric physicians. METHODS We searched the following databases: MEDLINE (1966-2005), Psych INFO (1967-2005) and CINAHL (1982-2005). To summarize data presented in the papers reviewed, we calculated the Summary receiver operating characteristic (ROC) and the summary sensitivity, specificity and odds ratios (ORs) of recognition, and their 95% confidence intervals using the random effects model. MEASUREMENTS AND MAIN RESULTS The summary sensitivity, specificity, and OR of recognition using the random effects model were: 36.4% (95% CI: 27.9-44.8), 83.7% (95% CI: 77.5-90.0), and 4.0 (95% CI: 3.2-4.9), respectively. We also calculated the Summary ROC. We performed a metaregression analysis, which showed that the method of documentation of recognition, the age of the sample, and the date of study publication have significant effect on the summary sensitivity and the odds of recognition, in the univariate model. Only the method of documentation had a significant effect on summary sensitivity, when the age of the sample and the date of publication were added to the model. CONCLUSION The accuracy of depression recognition by non-psychiatrist physicians is low. Further research should focus on developing standardized methods of documenting non-psychiatric physicians' recognition of depression.
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Affiliation(s)
- Monica Cepoiu
- Department of Clinical Epidemiology and Community Studies, St. Mary's Hospital, Montreal, QC, Canada.
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Tsao JCI, Dobalian A, Myers CD, Zeltzer LK. Pain and use of complementary and alternative medicine in a national sample of persons living with HIV. J Pain Symptom Manage 2005; 30:418-32. [PMID: 16310616 PMCID: PMC1420635 DOI: 10.1016/j.jpainsymman.2005.05.012] [Citation(s) in RCA: 32] [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] [Accepted: 05/13/2005] [Indexed: 11/18/2022]
Abstract
The current study investigated the relationship of pain to use of complementary and alternative medicine (CAM) in a U.S. nationally representative sample of 2466 persons with human immunodeficiency virus (HIV), using data from the HIV Cost and Services Utilization Study. Pain was conceptualized as a need characteristic within the context of predisposing, enabling, and need (PEN) characteristics following Andersen's Behavioral Model of Health Services Use. Multivariate analyses were used to examine the association of baseline PEN characteristics with CAM use by follow-up (approximately 6 months later), including use of five specific CAM domains. Change in pain from baseline to follow-up was also examined in relation to CAM use. Baseline pain was a strong predictor of CAM use, and increased pain over time was associated with use of unlicensed or underground drugs with potential for harm. These results highlight the importance of medical efforts to control pain in persons living with HIV.
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Affiliation(s)
- Jennie C I Tsao
- Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA
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Eberhardt MS, Pamuk ER. The importance of place of residence: examining health in rural and nonrural areas. Am J Public Health 2004; 94:1682-6. [PMID: 15451731 PMCID: PMC1448515 DOI: 10.2105/ajph.94.10.1682] [Citation(s) in RCA: 389] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We examined differences in health measures among rural, suburban, and urban residents and factors that contribute to these differences. Whereas differences between rural and urban residents were observed for some health measures, a consistent rural-to-urban gradient was not always found. Often, the most rural and the most urban areas were found to be disadvantaged compared with suburban areas. If health disparities are to be successfully addressed, the relationship between place of residence and health must be understood.
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Affiliation(s)
- Mark S Eberhardt
- National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Rd, Rm 6421, Hyattsville, MD 20782, USA.
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