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Senthinathan A, Penner M, Tu K, Morris AM, Craven BC, Jaglal SB. Identifying prescribers of antibiotics in a primary care spinal cord injury cohort. Spinal Cord Ser Cases 2024; 10:3. [PMID: 38302448 PMCID: PMC10834400 DOI: 10.1038/s41394-024-00615-8] [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: 11/18/2022] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024] Open
Abstract
STUDY DESIGN A retrospective cross-sectional study. OBJECTIVE To identify who prescribes outpatient antibiotics among a primary care spinal cord injury (SCI) cohort. SETTING ICES databases in Ontario, Canada. METHODS A cohort of individuals with SCI were retrospectively identified using a tested-algorithm and chart reviews in a primary care electronic medical records database. The cohort was linked to a drug dispensing database to obtain outpatient antibiotic prescribing information, and prescriber details were obtained from a physician database. RESULTS Final cohort included three hundred and twenty individuals with SCI. The average annual number of antibiotic courses dispensed for the SCI cohort was 2.0 ± 6.2. For dispensed antibiotics, 58.9% were prescribed by rostered-primary care practice physicians, compared to 17.9% by emergency and non-rostered primary care physicians, 17.4% by specialists and 6.1% by non-physician prescribers. Those who lived in urban areas and rural areas, compared to those who lived in suburban areas, were more likely to receive antibiotics from emergency and non-rostered primary care physicians than from rostered-primary care practice physicians. CONCLUSION Although individuals with SCI received outpatient antibiotic prescriptions from multiple sources, physicians from an individual's rostered-primary care practice were the main antibiotic prescribers. As such, interventions to optimize antibiotics use in the SCI population should target the primary care practice.
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Affiliation(s)
- Arrani Senthinathan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
| | - Melanie Penner
- Bloorview Research Institute/Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, ON, Canada
| | - Andrew M Morris
- Antimicrobial Stewardship Program, University Health Network, Toronto, ON, Canada
- Department of Medicine, Division of Infectious Diseases, Sinai Health, University Health Network, and University of Toronto, Toronto, ON, Canada
| | - B Catharine Craven
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Susan B Jaglal
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
- Rehabilitation Science Institute and Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
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Valentine JA, Delgado LF, Haderxhanaj LT, Hogben M. Improving Sexual Health in U.S. Rural Communities: Reducing the Impact of Stigma. AIDS Behav 2022; 26:90-99. [PMID: 34436713 PMCID: PMC8390058 DOI: 10.1007/s10461-021-03416-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022]
Abstract
Sexually transmitted infections (STI), including HIV, are among the most reported diseases in the U.S. and represent some of America’s most significant health disparities. The growing scarcity of health care services in rural settings limits STI prevention and treatment for rural Americans. Local health departments are the primary source for STI care in rural communities; however, these providers experience two main challenges, also known as a double disparity: (1) inadequate capacity and (2) poor health in rural populations. Moreover, in rural communities the interaction of rural status and key determinants of health increase STI disparities. These key determinants can include structural, behavioral, and interpersonal factors, one of which is stigma. Engaging the expertise and involvement of affected community members in decisions regarding the needs, barriers, and opportunities for better sexual health is an asset and offers a gateway to sustainable, successful, and non-stigmatizing STI prevention programs.
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Affiliation(s)
- Jo A Valentine
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA.
| | - Lyana F Delgado
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Laura T Haderxhanaj
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
| | - Matthew Hogben
- Division of STD Prevention, NCHHSTP, Centers for Disease Control, 1600 Clifton Road, MS US12-3, Atlanta, GA, 30333, USA
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3
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Comparison of Visit Length and Waiting Time of Patients in Public and Private Clinics in the North of Iran. HEALTH SCOPE 2021. [DOI: 10.5812/jhealthscope.112698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The visit length is considered one of the indicators for assessing patients’ satisfaction. Factors such as waiting time for getting a visit affects the desirability of the visit. Objectives: This study aimed to investigate the visit length and waiting time of patients in public and private clinics in Tabriz. Methods: This is a descriptive-analytic study conducted in five clinics in 2018. A questionnaire-based survey was used to collect data from 386 participants recruited through simple random sampling. Mann-Whitney U and Kruskal-Wallis tests were applied to analyze the data using SPSS version 22.0. Results: Overall, the mean visit length was 25.5 and 25.4 min in public and private centers, respectively, while the mean waiting time was 141.2 and 156.4 min in public and private centers, respectively. There was no significant difference between public and private centers regarding the visit length (P > 0.05); however, there was a significant difference between public and private centers in terms of waiting time (P < 0.05). Conclusions: The waiting time was too much, especially in private clinics, which can negatively affect patient satisfaction. Therefore, suggested interventions may consist of using internet and telephone admission, scheduling a waiting list, and requiring physicians to be present on time.
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Locklar LRB, Do DP. Rural-urban differences in HPV testing for cervical cancer screening. J Rural Health 2021; 38:409-415. [PMID: 34506669 DOI: 10.1111/jrh.12615] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE Rural preventable cancer disparities are often attributed in part to lower screening rates secondary to compromised health care access. When considering higher cervical cancer incidence and mortality, existing analyses primarily consider differences in Pap testing rather than the preferred method of HPV testing, which is more sensitive in identifying severe cases of cervical dysplasia. METHODS Logistic regression using data from the 2016 and 2018 Behavioral Risk Factor Surveillance System was used to examine urban and rural rates of cervical cancer screening according to national guidelines. Propensity score weighting was used to account for baseline sociodemographic differences between rural and urban populations in the 2016 landline sample. FINDINGS In 2016 and 2018, rural women were less likely than urban women to have current cervical cancer screening. This disparity was explained by sociodemographic variables in 2016. Among women with current cervical cancer screening, rural women were significantly less likely than urban women to undergo HPV testing in both 2016 and 2018. CONCLUSION Rural women with current cervical cancer screening were significantly less likely than their urban counterparts to have HPV testing. It is possible that updates to preventive care guidelines may be slower to reach rural providers, rural patients may be unaware that HPV testing was completed, or rural practice configuration may complicate the integration of HPV testing into clinical practice. Failure to undergo HPV testing may lead to delayed cervical dysplasia diagnosis, missed opportunities for early intervention, and contribute to rural/urban disparities in cervical cancer incidence and mortality.
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Affiliation(s)
- Lindsay R B Locklar
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - D Phuong Do
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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5
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Urban-Rural Disparities in the Incidence of Diabetes-Related Complications in Taiwan: A Propensity Score Matching Analysis. J Clin Med 2020; 9:jcm9093012. [PMID: 32962006 PMCID: PMC7565280 DOI: 10.3390/jcm9093012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 12/20/2022] Open
Abstract
Although a disparity has been noted in the prevalence and outcome of chronic disease between rural and urban areas, studies about diabetes-related complications are lacking. The purpose of this study was to examine the association between urbanization and occurrence of diabetes-related complications using Taiwan’s nationwide diabetic mellitus database. In total, 380,474 patients with newly diagnosed type 2 diabetes between 2000 and 2008 were included and followed up until 2013 or death; after propensity score matching, 31,310 pairs were included for analysis. Occurrences of seven diabetes-related complications of interest were identified. Cox proportional hazards model was used to determine the time-to-event hazard ratio (HR) among urban, suburban and rural groups. We found that the HRs of all cardiovascular events during the five-year follow-up was 1.04 times (95% confidence interval (CI) 1.00–1.07) and 1.15 times (95% CI 1.12–1.19) higher in suburban and rural areas than in urban areas. Patients in suburban and rural areas had a greater likelihood of congestive heart failure, stroke, and end-stage renal disease than those in urban areas. Moreover, patients in rural areas had a higher likelihood of ischemic heart disease, blindness, and ulcer than those in urban areas. Our empirical findings provide evidence for potential urban–rural disparities in diabetes-related complications in Taiwan.
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Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation. Drugs Aging 2019; 37:115-123. [DOI: 10.1007/s40266-019-00728-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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7
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Sears JM, Edmonds AT, Fulton-Kehoe D. Tracking Opioid Prescribing Metrics in Washington State (2012-2017): Differences by County-Level Urban-Rural and Economic Distress Classifications. J Rural Health 2019; 36:152-166. [PMID: 31583779 DOI: 10.1111/jrh.12400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/04/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE High-risk opioid prescribing is a critical driver of prescription opioid-related morbidity and mortality. This study explored opioid prescribing patterns across urban-rural and economic distress classifications. Secondarily, this study explored the urban-rural distribution of relevant health services, economic factors, and population characteristics. METHODS County-level opioid prescribing metrics were based on quarterly Washington State Prescription Monitoring Program data (2012-2017). Counties were classified using the 2013 National Center for Health Statistics Urban-Rural Classification Scheme for Counties, and Washington State unemployment-based distressed areas. County-level measures from Area Health Resources Files were used to describe the urban-rural continuum. FINDINGS Persistent economic distress was associated with higher-risk opioid prescribing. The large central metropolitan category had lower-risk opioid prescribing metrics than the other 5 urban-rural categories, which were similar to each other and not ordered by degree of rurality. High-risk prescribing declined over time, without notable trend divergence by either urban-rural or economic distress classifications. CONCLUSIONS The most striking urban-rural differences in opioid prescribing metrics were between large central metropolitan and all other categories; thus, we recommend caution when collapsing urban-rural categories for analysis. Further research is needed regarding geographic and economic patterning of opioid prescribing practices, as well as the dissemination of guidelines and best practices across the urban-rural continuum. Finally, the multiple intertwined burdens faced by rural communities-higher-risk prescribing practices, higher opioid morbidity and mortality rates, and fewer resources for primary care, mental health care, alternative pain treatment, and opioid use disorder treatment-must be addressed as an urgent public health priority.
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Affiliation(s)
- Jeanne M Sears
- Department of Health Services, University of Washington, Seattle, Washington.,Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington.,Institute for Work & Health, Toronto, Ontario, Canada
| | - Amy T Edmonds
- Department of Health Services, University of Washington, Seattle, Washington
| | - Deborah Fulton-Kehoe
- Department of Environmental & Occupational Health Sciences, University of Washington, Seattle, Washington
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8
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Delivering clinical preventive services in the Islamic Republic of Iran: A model for screening and behavior consultation practices. Med J Islam Repub Iran 2019; 32:125. [PMID: 30815420 PMCID: PMC6387821 DOI: 10.14196/mjiri.32.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Indexed: 11/18/2022] Open
Abstract
Background: Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated.
Methods: An analysis of current situation, learned lessons and future scopes of country’s preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran.
Results: Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules.
Conclusion: The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).
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9
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Hardin HK, McCarthy VL, Speck BJ, Crawford TN. Diminished Trust of Healthcare Providers, Risky Lifestyle Behaviors, and Low Use of Health Services: A Descriptive Study of Rural Adolescents. J Sch Nurs 2018; 34:458-467. [PMID: 28823198 PMCID: PMC5629118 DOI: 10.1177/1059840517725787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of our study was to determine the extent to which individual characteristic variables predict trust of healthcare provider (HCP), lifestyle behaviors, and use of health services among adolescents attending public high school in rural Indiana. The sample included 224 individuals surveyed in 9th grade or 12th grade required courses. Trust of HCP and lifestyle behaviors were predicted using hierarchical multiple regression; number of HCP visits and emergency department (ED) visits in the past 12 months were predicted using negative binomial regression. This sample of adolescents living in a rural area reported riskier lifestyle behaviors than another sample of adolescents, lower trust of HCP than adults in general, and fewer HCP and ED visits than adolescents in general. Our study supports the need for school-based health services in rural areas and the opportunity for school nurses to act as care coordinators for marginalized youth.
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Affiliation(s)
- Heather K. Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barbara J. Speck
- School of Nursing, University of Louisville, Louisville, KY, USA
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10
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Cheng BR, Chang HT, Lin MH, Chen TJ, Chou LF, Hwang SJ. Rural-urban disparities in family physician practice patterns: A nationwide survey in Taiwan. Int J Health Plann Manage 2018; 34:e464-e473. [PMID: 30238506 DOI: 10.1002/hpm.2662] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION In a world with increasing urbanization, rural-urban disparities in health care utilization have been a long-term concern. However, the details regarding the practice patterns of family physicians in Taiwan have not received sufficient attention thus far. METHODS The National Health Insurance Research Database of Taiwan offered 0.2% of the total ambulatory visit records for Taiwan in 2013. Records from community clinics of family medicine were collected, with the clinics categorized as rural, suburban, or urban area clinics according to their locations. RESULTS Among 100 334 visits to family medicine clinics, the median patient age was 50 years for urban clinics, 51 for suburban clinics, and 58 for rural clinics. The distributions of patient ages differed in the three areas (P < 0.001). Four types of chronic diseases (cardiovascular diseases, diabetes, chronic respiratory diseases, and cancers) accounted for 10.8%, 11.3%, and 13.6%, of the visits to urban, suburban, and rural clinics, respectively. The most common procedure was wound treatment, and the pattern of the top 10 procedures was similar in the three areas. CONCLUSION Although rural patients in Taiwan were older and had more chronic diseases than urban and suburban patients, the pattern of procedures undertaken by rural family physicians did not differ from those of urban and suburban family physicians.
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Affiliation(s)
- Bo-Ren Cheng
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Identifying Barriers to Access and Utilization of Preventive Health-Care Services by Young Adults in Vermont. J Adolesc Health 2018; 62:674-680. [PMID: 29784113 DOI: 10.1016/j.jadohealth.2017.12.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/13/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The objective of this study was to examine barriers to accessing and utilizing routine preventive health-care checkups for Vermont young adults. METHODS A population-based analysis was conducted using aggregated data from the 2011-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys of Vermont young adults aged 18-25 years (N = 1,329). Predictors analyzed as barriers were classified county of residence, health-care coverage, and annual household income level, as well as covariates, with the outcome of the length of time since the last routine checkup. RESULTS A total of 81.1% of Vermont young adults reported having a routine checkup in the past 2 years. Health-care coverage was a predictor of undergoing routine checkups within the past 2 years, with 85.2% of insured respondents undergoing checkups compared with 56.3% of uninsured respondents (p < .001). Additionally, 81.9% of respondents from Vermont counties classified as mostly rural reported undergoing a checkup within the past 2 years (p < .05). A total of 80.8% of respondents from the middle level (p < .05) and 89.0% of respondents from the highest level (p < .001) of annual household incomes reported undergoing a checkup in the past 2 years. Finally, age (p < .001) and sex (p < .01) were shown to indicate receipt of routine preventive checkups more often. CONCLUSIONS For Vermont young adults, health-care coverage, classified county of residence, and household income level were shown to be indicators of undergoing routine preventive health care more often. Further investigation is needed to examine how these barriers may impede preventive screenings, thereby contributing to the ongoing development of health-care guidelines and policies for young adults in rural settings.
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Liss DT, Serrano E, Wakeman J, Nowicki C, Buchanan DR, Cesan A, Brown T. "The Doctor Needs to Know": Acceptability of Smartphone Location Tracking for Care Coordination. JMIR Mhealth Uhealth 2018; 6:e112. [PMID: 29728349 PMCID: PMC5960037 DOI: 10.2196/mhealth.9726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 03/08/2018] [Accepted: 03/13/2018] [Indexed: 12/03/2022] Open
Abstract
Background Care coordination can be highly challenging to carry out. When care is fragmented across health systems and providers, there is an increased likelihood of hospital readmissions and wasteful health care spending. During and after care transitions, smartphones have the potential to bolster information transfer and care coordination. However, little research has examined patients’ perceptions of using smartphones to coordinate care. Objective This study’s primary objective was to explore patient acceptability of a smartphone app that could facilitate care coordination in a safety net setting. Our secondary objective was to identify how clinicians and other members of primary care teams could use this app to coordinate care. Methods This qualitative study was conducted at a federally qualified health center in metropolitan Chicago, IL. We conducted four focus groups (two in English, two in Spanish) with high-risk adults who owned a smartphone and received services from an organizational care management program. We also conducted structured interviews with clinicians and a group interview with care managers. Focus groups elicited patients’ perceptions of a smartphone app designed to: (1) identify emergency department (ED) visits and inpatient stays using real-time location data; (2) send automated notifications (ie, alerts) to users’ phones, asking whether they were a patient in the hospital; and (3) send automated messages to primary care teams to notify them about patients’ confirmed ED visits and inpatient stays. Focus group transcripts were coded based on emergent themes. Clinicians and care managers were asked about messages they would like to receive from the app. Results Five main themes emerged in patient focus group discussions. First, participants expressed a high degree of willingness to use the proposed app during inpatient stays. Second, participants expressed varying degrees of willingness to use the app during ED visits, particularly for low acuity ED visits. Third, participants stated their willingness to have their location tracked by the proposed app due to its perceived benefits. Fourth, the most frequently mentioned barriers to acceptability were inconveniences such as “false alarm” notifications and smartphone battery drainage. Finally, there was some tension between how to maximize usability without unnecessarily increasing user burden. Both clinicians and care managers expressed interest in receiving messages from the app at the time of hospital arrival and at discharge. Clinicians were particularly interested in conducting outreach during ED visits and inpatient stays, while care managers expressed more interest in coordinating postdischarge care. Conclusions High-risk primary care patients in a safety net setting reported a willingness to utilize smartphone location tracking technology to facilitate care coordination. Further research is needed on the development and implementation of new smartphone-based approaches to care coordination.
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Affiliation(s)
- David T Liss
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eloisa Serrano
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Julie Wakeman
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Christine Nowicki
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - Ana Cesan
- Erie Family Health Center, Chicago, IL, United States
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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13
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Khan A, Thapa JR, Zhang D. Preventive Dental Checkups and Their Association With Access to Usual Source of Care Among Rural and Urban Adult Residents. J Rural Health 2017; 33:419-426. [PMID: 28905468 DOI: 10.1111/jrh.12271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/18/2017] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to assess the relationship between rural or urban residence and having a usual source of care (USC), and the utilization of preventive dental checkups among adults. METHODS Cross-sectional analysis was conducted using data from the Medical Expenditure Panel Survey 2012. We performed a logit regression on the relationship between rural and urban residence, having a USC, and having at least 1 dental checkup in the past year, adjusting for sociodemographic characteristics and health status. FINDINGS After controlling for covariates, rural adult residents had significantly lower odds of having at least 1 dental checkup per year compared to their urban counterparts (odds ratio [OR] = 0.73, 95% confidence interval [CI]: 0.62-0.86, P < .001). Additionally, individuals with a USC had higher odds of having at least 1 dental checkup per year (OR = 1.76, 95% CI: 1.59-1.95, P < .001). Among both rural and urban residents, having a USC was significantly associated with an 11% (95% CI = 9%-13%) increase in the probability of having a preventive dental checkup within a year. CONCLUSIONS Individuals with a USC were more likely to obtain a preventive dental visit, with similar effects in rural and urban settings. We attributed the lower odds of having a checkup in rural regions to the lower density of oral health care providers in these areas. Integration of rural oral health care into primary care may help mitigate the challenges due to a shortage of oral health care providers in rural areas.
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Affiliation(s)
- Aishah Khan
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Janani R Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
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14
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Youatt EJ, Harris LH, Harper GW, Janz NK, Bauermeister JA. Sexual Health Care Services among Young Adult Sexual Minority Women. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2017; 14:345-357. [PMID: 28989554 PMCID: PMC5626006 DOI: 10.1007/s13178-017-0277-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Young adult sexual minority women (YSMW) are at elevated risk for negative reproductive health outcomes, yet are less likely than heterosexual peers to utilize preventive health care. Medical and public health policy organizations advocate sexual orientation disclosure ("coming out") to health care providers as a strategy for increasing service utilization among YSMW. Limited research explores relationships between disclosure and receipt of sexual health services. YSMW (N=285) ages 21-24 participated in an online survey assessing their health behaviors and care utilization. We employed multivariable logistic regression models to examine the association between receipt of sexual health services and sexual orientation disclosure to provider, after adjusting for sociodemographic covariates. Thirty-five percent of YSMW were out to their provider. Less than half the sample had received Pap screening or STI testing in the previous year; approximately 15% had received at least one dose of the HPV vaccination. Disclosure was associated with increased likelihood of Pap screening (OR=2.66, p<.001) and HPV vaccination (OR=4.30, p<.001), but was not significantly associated with STI testing. Promoting coming out to providers may be a promising approach to increase sexual health care use among YSMW. Future research should explore causal relationships between these factors.
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Affiliation(s)
- Emily J. Youatt
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lisa H. Harris
- Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Nancy K. Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI
| | - José A. Bauermeister
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
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15
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Ammi M, Peyron C. Heterogeneity in general practitioners' preferences for quality improvement programs: a choice experiment and policy simulation in France. HEALTH ECONOMICS REVIEW 2016; 6:44. [PMID: 27637834 PMCID: PMC5025412 DOI: 10.1186/s13561-016-0121-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/08/2016] [Indexed: 05/27/2023]
Abstract
Despite increasing popularity, quality improvement programs (QIP) have had modest and variable impacts on enhancing the quality of physician practice. We investigate the heterogeneity of physicians' preferences as a potential explanation of these mixed results in France, where the national voluntary QIP - the CAPI - has been cancelled due to its unpopularity. We rely on a discrete choice experiment to elicit heterogeneity in physicians' preferences for the financial and non-financial components of QIP. Using mixed and latent class logit models, results show that the two models should be used in concert to shed light on different aspects of the heterogeneity in preferences. In particular, the mixed logit demonstrates that heterogeneity in preferences is concentrated on the pay-for-performance component of the QIP, while the latent class model shows that physicians can be grouped in four homogeneous groups with specific preference patterns. Using policy simulation, we compare the French CAPI with other possible QIPs, and show that the majority of the physician subgroups modelled dislike the CAPI, while favouring a QIP using only non-financial interventions. We underline the importance of modelling preference heterogeneity in designing and implementing QIPs.
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Affiliation(s)
- Mehdi Ammi
- School of Public Policy and Administration, Carleton University, River Building, 1125 Colonel By Drive, Ottawa, ON, K1S 5B6, Canada.
| | - Christine Peyron
- Laboratoire d'Économie de Dijon, Université de Bourgogne, CNRS UMR 6307, Inserm U 1200, Dijon, France
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Kozhimannil KB, Karaca-Mandic P, Blauer-Peterson CJ, Shah NT, Snowden JM. Uptake and Utilization of Practice Guidelines in Hospitals in the United States: the Case of Routine Episiotomy. Jt Comm J Qual Patient Saf 2016; 43:41-48. [PMID: 28334585 DOI: 10.1016/j.jcjq.2016.10.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The gap between publishing and implementing guidelines differs based on practice setting, including hospital geography and teaching status. On March 31, 2006, a Practice Bulletin published by the American College of Obstetricians and Gynecologists (ACOG) recommended against the routine use of episiotomy and urged clinicians to make judicious decisions to restrict the use of the procedure. OBJECTIVE This study investigated changes in trends of episiotomy use before and after the ACOG Practice Guideline was issued in 2006, focusing on differences by hospital geographic location (rural/urban) and teaching status. METHODS In a retrospective analysis of discharge data from the Nationwide Inpatient Sample (NIS)-a 20% sample of US hospitals-5,779,781 hospital-based births from 2002 to 2011 (weighted N = 28,067,939) were analyzed using multivariable logistic regression analysis to measure odds of episiotomy and trends in episiotomy use in vaginal deliveries. RESULTS The overall episiotomy rate decreased from 20.3% in 2002 to 9.4% in 2011. Across all settings, a comparatively larger decline in episiotomy rates preceded the issuance of the ACOG Practice Guideline (34.0% decline), rather than following it (23.9% decline). The episiotomy rate discrepancies between rural, urban teaching, and urban nonteaching hospitals remained steady prior to the guideline's release; however, differences between urban nonteaching and urban teaching hospitals narrowed between 2007 and 2011 after the guideline was issued. CONCLUSION Teaching status was a strong predictor of odds of episiotomy, with urban nonteaching hospitals having the highest rates of noncompliance with evidence-based practice. Issuance of clinical guidelines precipitated a narrowing of this discrepancy.
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Ramirez-Andreotta MD, Brody JG, Lothrop N, Loh M, Beamer PI, Brown P. Improving Environmental Health Literacy and Justice through Environmental Exposure Results Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E690. [PMID: 27399755 PMCID: PMC4962231 DOI: 10.3390/ijerph13070690] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/18/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
Understanding the short- and long-term impacts of a biomonitoring and exposure project and reporting personal results back to study participants is critical for guiding future efforts, especially in the context of environmental justice. The purpose of this study was to evaluate learning outcomes from environmental communication efforts and whether environmental health literacy goals were met in an environmental justice community. We conducted 14 interviews with parents who had participated in the University of Arizona's Metals Exposure Study in Homes and analyzed their responses using NVivo, a qualitative data management and analysis program. Key findings were that participants used the data to cope with their challenging circumstances, the majority of participants described changing their families' household behaviors, and participants reported specific interventions to reduce family exposures. The strength of this study is that it provides insight into what people learn and gain from such results communication efforts, what participants want to know, and what type of additional information participants need to advance their environmental health literacy. This information can help improve future report back efforts and advance environmental health and justice.
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Affiliation(s)
- Monica D Ramirez-Andreotta
- Department of Soil, Water, and Environmental Science, University of Arizona, 1177 East 4th Street, Tucson, AZ 85721, USA.
| | - Julia Green Brody
- Silent Spring Institute, 320 Nevada Street, Suite 302, Newton, MA 02460, USA.
| | - Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona 1295 N Martin Ave, Tucson, AZ 85724, USA.
| | - Miranda Loh
- Mel and Enid Zuckerman College of Public Health, University of Arizona 1295 N Martin Ave, Tucson, AZ 85724, USA.
- Institute of Occupational Medicine, Research Avenue North Riccarton, Currie EH14 4AP, UK.
| | - Paloma I Beamer
- Mel and Enid Zuckerman College of Public Health, University of Arizona 1295 N Martin Ave, Tucson, AZ 85724, USA.
| | - Phil Brown
- Department of Sociology and Anthropology and Department of Health Sciences, Northeastern University, 360 Huntington Avenue, 310INV, Boston, MA 02115, USA.
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Morton S, Shih SC, Winther CH, Tinoco A, Kessler RS, Scholle SH. Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians. Ann Fam Med 2015; 13:250-6. [PMID: 25964403 PMCID: PMC4427420 DOI: 10.1370/afm.1797] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 03/28/2015] [Accepted: 04/05/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Health information technology (IT) offers promising tools for improving care coordination. We assessed the feasibility and acceptability of 6 proposed care coordination objectives for stage 3 of the Centers for Medicare and Medicaid Services electronic health record incentive program (Meaningful Use) related to referrals, notification of care from other facilities, patient clinical summaries, and patient dashboards. METHODS We surveyed physician-owned and hospital/health system-affiliated primary care practices that achieved patient-centered medical home recognition and participated in the Meaningful Use program, and community health clinics with patient-centered medical home recognition (most with certified electronic health record systems). The response rate was 35.1%. We ascertained whether practices had implemented proposed objectives and perceptions of their importance. We analyzed the association of organizational and contextual factors with self-reported use of health IT to support care coordination activities. RESULTS Although 78% of the 350 respondents viewed timely notification of hospital discharges as very important, only 48.7% used health IT systems to accomplish this task. The activity most frequently supported by health IT was providing clinical summaries to patients, in 76.6% of practices; however, merely 47.7% considered this activity very important. Greater use of health IT to support care coordination activities was positively associated with the presence of a nonclinician responsible for care coordination and the practice's capacity for systematic change. CONCLUSIONS Even among practices having a strong commitment to the medical home model, the use of health IT to support care coordination objectives is not consistent. Health IT capabilities are not currently aligned with clinicians' priorities. Many practices will need financial and technical assistance for health IT to enhance care coordination.
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Affiliation(s)
- Suzanne Morton
- National Committee for Quality Assurance, Washington, DC
| | - Sarah C Shih
- Primary Care Information Project, New York City Department of Health and Mental Hygiene, New York, New York
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