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Nagahawatta DP, Liyanage NM, Jayawardena TU, Jeon YJ. Marine Polyphenols in Cardiovascular Health: Unraveling Structure-Activity Relationships, Mechanisms, and Therapeutic Implications. Int J Mol Sci 2024; 25:8419. [PMID: 39125987 PMCID: PMC11312663 DOI: 10.3390/ijms25158419] [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: 06/19/2024] [Revised: 07/24/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Cardiovascular diseases (CVDs) are responsible for significant mortality rates globally that have been raised due to the limitation of the available treatments and prevalence of CVDs. The innovative research and identification of potential preventives for CVDs are essential to alleviate global deaths and complications. The marine environment is a rich source of bioactive substances and provides a unique chemical arsenal against numerous ailments due to its unrivaled biodiversity. Marine polyphenolic compounds (MPCs) are unique because of their structural variety and biologically significant activity. Further, MPCs are well-reported for their valuable biological activities, such as anti-inflammatory, cardioprotective, and antioxidant, demonstrating encouraging results in preventing and treating CVDs. Therefore, investigation of the structure-activity relationship (SAR) between MPCs and CVDs provides insights that reveal how the structural components of these compounds affect their effectiveness. Further, comprehending this correlation is essential for advancing medications and nutraceuticals sourced from marine sources, which could transform the strategy for treating and preventing cardiovascular diseases. Therefore, this study provides a comprehensive analysis of existing research by emphasizing the role of MPCs in CVD treatments and evaluating the SAR between MPCs and CVDs with challenges and future directions.
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Affiliation(s)
- D. P. Nagahawatta
- Department of Marine Life Sciences, Jeju National University, Jeju 63243, Republic of Korea; (D.P.N.); (N.M.L.)
| | - N. M. Liyanage
- Department of Marine Life Sciences, Jeju National University, Jeju 63243, Republic of Korea; (D.P.N.); (N.M.L.)
| | | | - You-Jin Jeon
- Department of Marine Life Sciences, Jeju National University, Jeju 63243, Republic of Korea; (D.P.N.); (N.M.L.)
- Marine Science Institute, Jeju National University, Jeju 63333, Republic of Korea
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2
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Osebo C, Grushka J, Deckelbaum D, Razek T. Assessing Ethiopia's surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade? Surg Open Sci 2024; 19:70-79. [PMID: 38595832 PMCID: PMC11002296 DOI: 10.1016/j.sopen.2024.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024] Open
Abstract
Background Surgical, anesthetic, and obstetric (SAO) care plays a crucial role in global health, recognized by the World Health Organization (WHO) and The Lancet Commission on Global Surgery (LCoGS). LCoGS outlines six indicators for integrating SAO services into a country's healthcare system through National Surgical Obstetrics and Anesthesia Plans (NSOAPs). In Ethiopia, surgical services progress lacks evaluation. This study assesses current Ethiopian surgical capacity using the LCoGS NSOAPs framework. Methods We conducted a narrative review of published literature on critical LCoGS NSAOPs metrics to extract information on key domains; service delivery, workforce, infrastructure, finance, and information management. Results Ethiopia's surgical services face challenges, including a low surgical volume (43) and a scarcity of specialist SOA physicians (0.5) per 100,000 population. Over half of Ethiopians reside outside the 2-hour radius of surgery-ready hospitals, and 98 % face surgery-related impoverished expenditures. Lacking the LCoGS-recommended SOA reporting systems, approximately 44 % of facilities exist for handling bellwether procedures. Despite the prevalence of essential surgeries, primary district hospitals have limited operative infrastructures, resulting in disparities in the surgical landscape. Most surgery-ready facilities are concentrated in cities, leaving Ethiopia's 80 % rural population with inadequate access to surgical care. Conclusion Ethiopia's surgical capacity falls below LCoGS NSOAPs recommendations, with challenges in infrastructure, personnel, and data retrieval. Critical measures include scaling up access, workforce, public insurance, and information management to enhance SAO services. Ethiopia pioneered in Sub-Saharan Africa by establishing Saving Lives Through Safe Surgery (SaLTS) in response to NSOAPs, but progress lags behind LCoGS recommendations.
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Affiliation(s)
- Cherinet Osebo
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
- Hargelle Hospital, Emergency Surgery and Obstetrics Unit, Hargelle, Ethiopia
| | - Jeremy Grushka
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Dan Deckelbaum
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
| | - Tarek Razek
- McGill University Health Centre, Centre for Global Surgery, Department of Surgery, Montreal General Hospital, Montreal, Quebec, Canada
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3
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Cao L, Cai J, Gong Y, Bao Q, Hu J, Tang N. Health effect of public sports services and public health services: empirical evidence from China. Front Public Health 2024; 12:1320216. [PMID: 38803807 PMCID: PMC11128566 DOI: 10.3389/fpubh.2024.1320216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
There is no clear explanation for the extraordinary rebound in China's population mortality over the past decade. This paper utilizes panel data from 31 Chinese provinces from 2010 to 2020 to determine the distinct impacts of public sports services (PSS), public health services (PMS), and their interaction on population mortality. Empirical results show that public sports services significantly reduce mortality. Every unit increase in public sports services reduces mortality by about 2.3%. It is characterized by delayed realization. Public health services were surprisingly associated with a rebound in mortality. Further studies found strong health effect from interaction of public sports and health services. The effect was significantly strengthened in areas with fewer extreme temperatures or developed economy. The findings have important policy implications for the high-quality development of public sports and health services. It also emphasizes integration of sports and medicine and mitigates health risks associated with extreme temperatures.
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Affiliation(s)
- Lin Cao
- School of Physical Education, Hunan University of Science and Technology, Xiangtan, China
| | - Jianguang Cai
- School of Physical Education, Hunan University of Science and Technology, Xiangtan, China
| | - Yanping Gong
- Business School, Guilin University of Electronic Technology, Guilin, China
| | - Qingqing Bao
- Outdoor Sports Academy, Guilin Tourism University, Guilin, China
| | - Junrong Hu
- Department of Sports, Guilin University of Electronic Technology, Guilin, China
| | - Ningxiao Tang
- School of Physical Education, Hunan University of Science and Technology, Xiangtan, China
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4
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Hyman DA, Letchuman S, Bai G. Health Insurance Coverage-Is Broader Always Better? JAMA Intern Med 2024; 184:233-234. [PMID: 38252444 DOI: 10.1001/jamainternmed.2023.7112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This Viewpoint discusses the traditional goals of health insurance and contrasts those with the current needs of insurance beneficiaries.
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Affiliation(s)
| | | | - Ge Bai
- Johns Hopkins Carey Business School, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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5
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Lawless MT, Tieu M, Golley R, Kitson A. How and where does "care" fit within seminal life-course approaches? A narrative review and critical analysis. J Adv Nurs 2024; 80:871-883. [PMID: 37684708 DOI: 10.1111/jan.15852] [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: 05/15/2023] [Revised: 08/07/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
Abstract
AIMS To map the concepts of the caring life-course theory that are used in life-course approaches from different disciplines; establish whether there is a common recognition of, or language used, to describe care in those life-course approaches; and identify the role and contribution of care to the life-course literature. DESIGN This discursive paper uses a narrative review process to explore points of convergence and divergence between life-course approaches and the caring life-course theory. METHODS Categories for analysis were developed deductively and inductively, focusing on the constructs of fundamental care, capacity and capability, care network, care transition, care trajectory and care biography. RESULTS We identified four disciplinary perspectives: (1) life-course sociology; (2) life-course epidemiology; (3) lifespan developmental psychology; and (4) life-course health development. While six core constructs of the caring life-course theory were described, either explicitly or implicitly, in existing life-course approaches, no single approach fully describes the role and contribution of care across the lifespan. CONCLUSION Life-course approaches have largely neglected the contribution and role of care in informing the life-course discourse. This review highlights the significance of care beyond traditional healthcare settings and recognizes it as a fundamental human need for well-being and development, which can contribute to existing life-course literature. IMPLICATION FOR THE PROFESSION AND/OR PATIENT CARE There is a need to understand care as a complex system and embrace a whole-system, life-course approach to enable nurses and other healthcare professionals to provide high-quality, patient-centred care. IMPACT Incorporating care within a life-course approach provides opportunities to integrate and deliver care centred around the person, their life transitions, trajectories and care networks, including informal carers and healthcare professionals. NO PATIENT OR PUBLIC CONTRIBUTION Patients or members of the public were not involved in this study as it is a discursive paper based on the relevant literature.
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Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
- College of Humanities, Arts and Social Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Rebecca Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
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6
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Atherton OE, Willroth EC, Weston SJ, Mroczek DK, Graham EK. Longitudinal associations among the Big Five personality traits and healthcare utilization in the U.S. Soc Sci Med 2024; 340:116494. [PMID: 38101170 PMCID: PMC11065195 DOI: 10.1016/j.socscimed.2023.116494] [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: 11/08/2022] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE One critical component of individual and public health is healthcare utilization, or the extent to which individuals have routine check-ups, schedule treatments, or use emergency services. However, we know little about who uses healthcare services and what types, the conditions that exacerbate utilization, or the factors that explain why people seek out services. The present study fills these gaps in the literature by investigating the role of personality factors in predicting various forms of healthcare utilization, how these associations vary by age, socioeconomic resources, and chronic conditions, as well as one potential psychological mediating mechanism (i.e., sense of control). METHODS We use data from a large longitudinal sample of Americans (N = 7108), with three assessments spanning 20 years. Participants reported on their Big Five personality traits using the Midlife Development Inventory, healthcare utilization across three domains (routine visits, scheduled treatment, urgent care), age, income, insurance, chronic conditions, and sense of control. RESULTS Multilevel models showed that people who were more agreeable and neurotic tended to use more healthcare services. Moreover, on occasions when people were more extraverted and open, they tended to use more healthcare services. There were several nuances in personality-healthcare utilization associations depending on the type of healthcare service, age, and socioeconomic resources. Longitudinal mediation analyses demonstrated sense of control as one mechanism linking personality traits to healthcare utilization in the U.S. CONCLUSIONS We discuss the theoretical and practical implications of interactions between individuals and structural systems for promoting the health of aging U.S. Americans.
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Affiliation(s)
- Olivia E Atherton
- Department of Psychology, University of Houston, Houston, TX, USA; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Emily C Willroth
- Department of Psychological and Brain Sciences, Washington University in St. Louis, MO, USA
| | - Sara J Weston
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Daniel K Mroczek
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Psychology, Northwestern University, Chicago, IL, USA
| | - Eileen K Graham
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Jindal M, Chaiyachati KH, Fung V, Manson SM, Mortensen K. Eliminating health care inequities through strengthening access to care. Health Serv Res 2023; 58 Suppl 3:300-310. [PMID: 38015865 PMCID: PMC10684044 DOI: 10.1111/1475-6773.14202] [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] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To provide a research agenda and recommendations to address inequities in access to health care. DATA SOURCES AND STUDY SETTING The Agency for Healthcare Research and Quality (AHRQ) organized a Health Equity Summit in July 2022 to evaluate what equity in access to health care means in the context of AHRQ's mission and health care delivery implementation portfolio. The findings are a result of this Summit, and subsequent convenings of experts on access and equity from academia, industry, and the government. STUDY DESIGN Multi-stakeholder input from AHRQ's Health Equity Summit, author consensus on a framework and key knowledge gaps, and summary of evidence from the supporting literature in the context of the framework ensure comprehensive recommendations. DATA COLLECTION/EXTRACTION METHODS Through a stakeholder-engaged process, themes were developed to conceptualize access with a lens toward health equity. A working group researched the most appropriate framework for access to care to classify limitations identified during the Summit and develop recommendations supported by research in the context of the framework. This strategy was intentional, as the literature on inequities in access to care may itself be biased. PRINCIPAL FINDINGS The Levesque et al. framework, which incorporates multiple dimensions of access (approachability, acceptability, availability, accommodation, affordability, and appropriateness), is the backdrop for framing research priorities for AHRQ. However, addressing inequities in access cannot be done without considering the roles of racism and intersectionality. Recommendations include funding research that not only measures racism within health care but also tests burgeoning anti-racist practices (e.g., co-production, provider training, holistic review, discrimination reporting, etc.), acting as a convener and thought leader in synthesizing best practices to mitigate racism, and forging the path forward for research on equity and access. CONCLUSIONS AHRQ is well-positioned to develop an action plan, strategically fund it, and convene stakeholders across the health care spectrum to employ these recommendations.
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Affiliation(s)
- Monique Jindal
- Department of Academic Internal MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Krisda H. Chaiyachati
- Verily, Inc.South San FranciscoCaliforniaUSA
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Mongan InstituteMassachusetts General HospitalBostonMassachusettsUSA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native HealthUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Karoline Mortensen
- Department of Health Management and PolicyMiami Herbert Business SchoolCoral GablesFloridaUSA
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8
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Wildner M. Maria Theresia und ihre Kinder. DAS GESUNDHEITSWESEN 2023; 85:1107-1109. [PMID: 38081171 PMCID: PMC11248602 DOI: 10.1055/a-2187-7645] [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: 12/18/2023]
Abstract
Maria Theresia, Regentin von Österreich, Böhmen und Ungarn und ab
1745 auch Kaiserin des Heiligen Römischen Reichs, hatte kein leichtes Amt.
Als sie 1780 im Alter von 63 Jahren starb, hatte sie ihren Herrschaftsraum –
aus einer feudalen Staatsordnung kommend – im Sinne eines
„aufgeklärten Absolutismus“ umgestaltet. Ihr Mann, Kaiser
Franz, war bereits 1765 im Alter von 57 Jahren gestorben und ihr gemeinsamer Sohn
Joseph II. war als Kaiser und Mitregent an dessen Stelle getreten – er starb
1790 mit 48 Jahren. Von ihren 16 Kindern erreichten nur zwei mit jeweils 65 Jahren
ein höheres Lebensalter als sie selbst. Ein Kind war im ersten Lebensjahr
gestorben, fünf weitere Kinder vor ihrem 18. Geburtstag 1. Für Aufsehen sorgte auch der
frühe Tod ihrer 38jährigen Tochter Marie Antoinette 1793 durch eine
Guillotine der Französischen Revolution: Diese hatte dem dortigen,
unaufgeklärt gebliebenen Absolutismus ein Ende gesetzt. „Media
vita in morte sumus – Mitten im Leben sind wir im Tod“,
singt ein mittelalterlicher gregorianischer Choral.
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Gibbons JB, Cram P, Meiselbach MK, Anderson GF, Bai G. Comparison of social determinants of health in Medicaid vs commercial health plans. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad074. [PMID: 38756365 PMCID: PMC10986275 DOI: 10.1093/haschl/qxad074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 05/18/2024]
Abstract
Incorporating the measurement of social determinants of health (SDOH) into health care practice and US health policy reforms is a promising approach to improving population health nationwide. One way health care practitioners have started to incorporate consideration of SDOH in clinical care is by using International Classification of Diseases, Tenth Revision (ICD-10), Z-codes, a set of diagnosis codes spanning a range of social and economic circumstances. Our study summarizes Z-codes used by code type, setting, and patient demographics between Medicaid and commercial insurance to help identify strategies to optimize their use within each program and understand their differences. Overall, Z-code use was highly limited nationwide in Medicaid and commercial insurance between 2020 and 2021. Still, we found notable differences in the use of Z-codes between the programs; Medicaid beneficiaries were more likely to receive Z-codes related to financial and economic issues, while commercially insured beneficiaries were more likely to receive Z-codes indicating problems with social and familial relationships. Policy efforts focused on increasing the rate and ease of patient SDOH screening will potentially expand SDOH measurement and facilitate actions to address patient social needs.
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Affiliation(s)
- Jason Brian Gibbons
- Department of Health Systems, Management and Policy, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
| | - Peter Cram
- Department of Internal Medicine, The University of Texas Medical Branch School of Public and Population Health, Galveston, TX 77555, United States
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Mark K Meiselbach
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Ge Bai
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Johns Hopkins Carey Business School, Baltimore, MD 21202, United States
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Lemont B, Puro N, Franz B, Cronin CE. Efforts by critical access hospitals to increase health equity through greater engagement with social determinants of health. J Rural Health 2023; 39:728-736. [PMID: 37296509 DOI: 10.1111/jrh.12771] [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: 01/06/2023] [Revised: 04/21/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Greater health care engagement with social determinants of health (SDOH) is critical to improving health equity. However, no national studies have compared programs to address patient social needs among critical access hospitals (CAHs), which are lifelines for rural communities. CAHs generally have fewer resources and receive governmental support to maintain operations. This study considers the extent to which CAHs engage in community health improvement, particularly upstream SDOH, and whether organizational or community factors predict involvement. METHODS Using descriptive statistics and Poisson regression, we compared 3 types of programs (screening, in-house strategies, and external partnerships) to address the patient social needs between CAHs and non-CAHs, independent of key organizational, county, and state factors. FINDINGS CAHs were less likely than non-CAHs to have programs to screen patients for social needs, address unmet social needs of patients, and enact community partnerships to address SDOH. When we stratified hospitals according to whether they endorsed an equity-focused approach as an organization, CAHs matched their non-CAH counterparts on all 3 types of programs. CONCLUSIONS CAHs lag relative to their urban and non-CAH counterparts in their ability to address nonmedical needs of their patients and broader communities. While the Flex Program has shown success in offering technical assistance to rural hospitals, this program has mainly focused on traditional hospital services to address patients' acute health care needs. Our findings suggest that organizational and policy efforts surrounding health equity could bring CAHs in line with other hospitals in terms of their ability to support rural population health.
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Affiliation(s)
- Bethany Lemont
- Economics Department, Ohio University College of Arts & Sciences; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
| | - Neeraj Puro
- Management-Health Administration, Florida Atlantic University College of Business, Boca Raton, Florida, USA
| | - Berkeley Franz
- Department of Social Medicine, Ohio University Heritage College of Osteopathic Medicine; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
| | - Cory E Cronin
- Department of Social and Public Health, Ohio University College of Health Sciences and Professions; Appalachian Institute to Advance Health Equity Science, Athens, Ohio, USA
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Schriger DL, Schenkel S. Fine Wine or Stale Bread: The Aging Emergency Physician. Ann Emerg Med 2023; 82:313-315. [PMID: 37178099 DOI: 10.1016/j.annemergmed.2023.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 03/27/2023] [Accepted: 03/27/2023] [Indexed: 05/15/2023]
Affiliation(s)
- David L Schriger
- Department of Emergency Medicine, University of California Los Angeles, Los Angeles, CA.
| | - Stephen Schenkel
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
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12
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Kahn RS, Cheng TL, Mitchell MJ. A Framework for Pursuing Child Health Equity in Pediatric Practice. Pediatr Clin North Am 2023; 70:629-638. [PMID: 37422304 DOI: 10.1016/j.pcl.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/10/2023]
Abstract
This article brings together several disparate frameworks to help outline a needed shift in pediatric practice to ensure child health equity. That shift involves moving from a commitment to equal care delivery to an explicit commitment to equitable health outcomes. The frameworks describe (1) the distinct domains of child health where inequity can be expressed, (2) the shortfalls of equal care delivery in meeting that promise, (3) a coherent typology of the barriers that drive health inequity and (4) a characterization of interventions as downstream, midstream, and upstream in nature.
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Affiliation(s)
- Robert S Kahn
- University of Cincinnati, Michael Fisher Child Health Equity Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229-3026, USA.
| | - Tina L Cheng
- University of Cincinnati, Cincinnati Children's Research Foundation, Cincinnati Children's Hospital Medical Center, Michael Fisher Child Health Equity Center, 3333 Burnet Avenue MLC 3106, Cincinnati, OH 45229-3026, USA
| | - Monica J Mitchell
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati; Community Relations, Center for Clinical and Translational Science and Training, Community Engagement, Michael Fisher Child Health Equity Center, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 3015, Cincinnati, OH 45229-3026, USA
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Petruzzi L, Ewald B, Covington E, Rosenberg W, Golden R, Jones B. Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:147-160. [PMID: 35895505 DOI: 10.1080/19371918.2022.2104415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.
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Affiliation(s)
- Liana Petruzzi
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
| | - Bonnie Ewald
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Walter Rosenberg
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn Golden
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Barbara Jones
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
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14
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Petruzzi L, Vohra-Gupta S, Valdez C, Cubbin C. Nativity moderates the relationship between nationality and healthcare access for some Latinx women in the United States. ETHNICITY & HEALTH 2022; 27:1752-1768. [PMID: 34510969 PMCID: PMC10371217 DOI: 10.1080/13557858.2021.1976396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Gender has been identified as a social determinant of health, particularly as it relates to healthcare access for women of color. Yet, few analyses focus on the unique barriers that impact Latinx women's access to healthcare, which demonstrates a significant gap in the literature given the heterogeneity of the Latinx population. The purpose of this study is to (1) describe how sociodemographic characteristics impact access to healthcare for Latinx women and (2) examine whether intersecting factors, particularly nativity and nationality, influence barriers to healthcare for Latinx women in the United States (US). DESIGN An outcome variable called 'any barriers to care' was created based on four healthcare access variables: lacking a usual source of care and delayed care (medical, dental and prescription). Data were from the Medical Expenditure Panel Survey (2005-2015). The sample included Latinx women between ages 18 and 74 (N = 27,162), cross-classified by nationality and nativity. Control variables included language, age, marital status, education, income, and insurance status. Multivariate logistic regression models were used to assess nativity and nationality as a predictor of any barriers to care. RESULTS 37% of the sample experienced at least one barrier to care. Initially, nativity status was not a predictor of having a barrier to care. However, in adjusted models with cross-classified nativity and nationality variables, Mexican (US- and foreign-born), Cuban (US- and foreign-born) and Central/South American women (foreign-born only) had higher odds of having any barriers to care compared to continental US-born Puerto Rican women. CONCLUSIONS Latinx women experience barriers to healthcare, yet the prevalence rates vary widely depending on nationality and nativity. It is important to recognize the heterogeneity that exists within the Latinx community and address the underlying causes for limited healthcare access such as immigration policy.
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Affiliation(s)
- Liana Petruzzi
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
| | - Shetal Vohra-Gupta
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
| | - Carmen Valdez
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
- Population Health Department, Dell Medical School, Austin, USA
| | - Catherine Cubbin
- The Steve Hicks School of Social Work at the University of Texas at Austin, Austin, USA
- Population Health Department, Dell Medical School, Austin, USA
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15
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Hershberger PJ, Castle A, Soliman MM, Conway K. Social Accountability and Regional Health Priorities in Medical Education. MEDICAL SCIENCE EDUCATOR 2022; 32:683-686. [PMID: 35818615 PMCID: PMC9270508 DOI: 10.1007/s40670-022-01560-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 06/03/2023]
Abstract
Social accountability in medical education refers to the commitment of medical schools to address priority health concerns of the community. Over a 2-year period, 200 Family Medicine clerkship students ranked the topics most emphasized in the first 2 years of medical school. These rankings did not align with the community health priorities of the region in which the medical school is located. While the basic science and introductory clinical material covered early in medical school is necessary, our data suggest that emphasizing the implications of this foundational curricula for addressing the regions' health priorities is worthy of greater consideration.
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Affiliation(s)
- Paul J. Hershberger
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Angie Castle
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Miriam M. Soliman
- Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
| | - Katharine Conway
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, 725 University Blvd, Dayton, OH 45435 USA
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16
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Dixon AR, Adams LB, Ma T. Perceived healthcare discrimination and well-being among older adults in the United States and Brazil. SSM Popul Health 2022; 18:101113. [PMID: 35664925 PMCID: PMC9160820 DOI: 10.1016/j.ssmph.2022.101113] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/02/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022] Open
Abstract
Despite well-documented evidence illustrating the relationship between discrimination and health, less is known about the influence of unfair treatment when receiving medical care. Moreover, our current knowledge of cross-national and racial variations in healthcare discrimination is limited in aging populations. This article addresses these gaps using two harmonized data sets of aging populations to clarify the relationship between healthcare discrimination and health in the United States and Brazil. We use nationally representative, harmonized data from the Health and Retirement Study in the United States and the Brazilian Longitudinal Study of Aging to examine and compare perceived discrimination in the healthcare setting and its relationship to self-rated health, depression diagnosis, and depressive symptoms across national contexts. Using Poisson regression models and population attributable risk percent estimates, we found that aging adults reporting healthcare discrimination were at higher risk of poor self-rated health, diagnosed depression, and depressive symptoms. Our results also suggest that reducing perceived healthcare discrimination may contribute to improved self-rated health and mental well-being in later life across racialized societies. In two comparative settings, we highlight the differential impact of healthcare discrimination on self-rated health and depression. We describe the implications of our study's findings for national public health strategies focused on eliminating discrimination in the healthcare setting, particularly among aging countries.
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Affiliation(s)
| | - Leslie B. Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Maryland, United States
| | - Tszshan Ma
- Gangarosa Department of Environmental Health, Emory University, Georgia
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17
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Chandran M, Schulman KA. HSR Invited Commentary Racial Disparities in Healthcare and Health. Health Serv Res 2022; 57:218-222. [PMID: 35184275 PMCID: PMC8928009 DOI: 10.1111/1475-6773.13957] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mayuri Chandran
- Department of Medicine, School of Medicine Stanford University
| | - Kevin A. Schulman
- Clinical Excellence Research Center, School of Medicine Stanford University
- Graduate School of Business Stanford University
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18
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Zamora B, Towse A. The cost-per-QALY threshold in England: Identifying structural uncertainty in the estimates. FRONTIERS IN HEALTH SERVICES 2022; 2:936774. [PMID: 36925841 PMCID: PMC10012707 DOI: 10.3389/frhs.2022.936774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023]
Abstract
Introduction There are increasing numbers of estimates of opportunity cost to inform the setting of thresholds as ceiling cost-per-quality-adjusted life year (QALY) ratios. To understand their ability to inform policy making, we need to understand the degree of uncertainty surrounding these estimates. In particular, do estimates provide sufficient certainty that the current policy "rules" or "benchmarks" need revision? Does the degree of uncertainty around those estimates mean that further evidence generation is required? Methods We analyse uncertainty and methods from three papers that focus on the use of data from the NHS in England to estimate opportunity cost. All estimate the impact of expenditure on mortality in cross-sectional regression analyses and then translate the mortality elasticities into cost-per-QALY thresholds using the same assumptions. All three discuss structural uncertainty around the regression analysis, and report parameter uncertainty derived from their estimated standard errors. However, only the initial, seminal, paper explores the structural uncertainty involved in moving from the regression analysis to a threshold. We discuss the elements of structural uncertainty arising from the assumptions that underpin the translation of elasticities to thresholds and seek to quantify the importance of some of the effects. Results We find several sets of plausible structural assumptions that would place the threshold estimates from these studies within the current National Institute for Health and Care Excellence (NICE) range of £20,000 to £30,000 per QALY. Heterogeneity, an additional source of uncertainty from variability, is also discussed and reported. Discussion Lastly, we discuss how decision uncertainty around the threshold could be reduced, setting out what sort of additional research is required, notably in improving estimates of disease burden and of the impact of health expenditure on quality of life. Given the likely value to policy makers of this research it should be a priority for health system research funding.
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Affiliation(s)
- Bernarda Zamora
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Adrian Towse
- Office of Health Economics, London, United Kingdom
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19
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Finch T, Jonas MC, Rubenstein K, Watson E, Basra S, Martinez J, Horberg M. Life Expectancy Trends Among Integrated Health Care System Enrollees, 2014-2017. Perm J 2021; 25:20.286. [PMID: 35348069 PMCID: PMC8784056 DOI: 10.7812/tpp/20.286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) has reported downward trends in life expectancy and racial/ethnic differences between 2014 and 2017. OBJECTIVE To determine the life expectancy of the Kaiser Permanente Mid-Atlantic States (KPMAS) insured population as compared to the CDC National Vital Statistics data from 2014 to 2017. We also aimed to highlight the utilization of membership data to inform population statistical estimates such as life expectancy. We examine whether national trends in life expectancy are reflected in an insured population with relatively uniform access to care. METHODS This retrospective, data only study examined life expectancy between 2014 and 2017. Data from electronic medical records and the National Death Index were combined to construct complete life tables by race and sex for the KPMAS population, which was compared to the CDC National Vital Statistics data. RESULTS From 2014 to 2017, the overall KPMAS population life expectancy at birth varied between 84.6 and 85.2 years compared to the CDC reported national average of 78.6-78.9 years (p < 0.001). While the CDC dataset reported a 3.5- to 3.7-year life expectancy gap between non-Hispanic White and non-Hispanic Black populations, in the KPMAS population, this gap was significantly smaller (0.0-0.9 years). The gap in life expectancy between males and females was consistent across KPMAS and the CDC data; however, overall KPMAS male and female patient life expectancy was extended in comparison. CONCLUSION Among members who disclosed their race/ethnicity, KPMAS Hispanic, non-Hispanic Black, and non-Hispanic White members had significantly higher life expectancies than the CDC dataset in all years reported.
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Affiliation(s)
- Tori Finch
- Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - M Cabell Jonas
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Kevin Rubenstein
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Eric Watson
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Sundeep Basra
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
| | - Jose Martinez
- Mid-Atlantic Permanente Medical Group, Rockville, MD
| | - Michael Horberg
- Mid-Atlantic Permanente Medical Group, Rockville, MD
- Mid-Atlantic Permanente Research Institute, Rockville, MD
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20
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Chu QD, Hsieh MC, Gibbs JF, Wu XC. Social determinants of health associated with poor outcome for rural patients following resected pancreatic cancer. J Gastrointest Oncol 2021; 12:2567-2578. [PMID: 35070388 PMCID: PMC8748046 DOI: 10.21037/jgo-20-583] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/08/2021] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND The impact of rurality on outcome for patients who had resected pancreatic ductal adenocarcinoma (PDAC) is unclear. We hypothesize that poor outcomes for rural patients are associated with adverse social determinants of health (SDoH). The objective of this study is to assess the difference in overall survival (OS) of PDAC patients between rural, urban, and contributing factors. METHODS A cohort of 25,536 patients diagnosed with stage I-III pancreatic adenocarcinoma from 2003 to 2011 and underwent resection were evaluated from the National Cancer Database. Socioeconomic/demographic, clinicopathological, and treatment variables were compared between rural and urban residences. The 5-year OS was calculated using the Kaplan-Meier method. The Cox regression model was used to assess factors associated with OS. P value <0.05 was considered significant. RESULTS In univariate analysis, the rural residence was a predictor of poor OS. The 5-year OS for rural (N=4,389) and urban (N=21,147) was 18.8% (95% CI: 17.4-20.2%) and 22.3% (95% CI: 21.6-22.9%; P<0.0001), respectively. The risk of all causes of death was 10.3% higher (P<0.0001) in rural than urban patients. In multivariable analysis, rurality was not an independent predictor of OS (P=0.407). Independent predictors of worse OS included adverse social determinants of health associated with the rural population and these included a low income (P<0.0001), low education level (P<0.01), low insurance status (P<0.01), and treatment at a low-volume facility (P<0.0001). CONCLUSIONS Rural/urban outcome disparities for resected stage I-III pancreatic cancer outcome can be explained by adverse social determinants of health associated with rural population.
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Affiliation(s)
- Quyen D. Chu
- Departments of Surgery, LSU Health Sciences Center-Shreveport, Shreveport, Louisiana, USA
| | - Mei-Chin Hsieh
- Louisiana Tumor Registry & Epidemiology and School of Public Health at LSU Health Sciences-New Orleans, New Orleans, Louisiana, USA
| | - John F. Gibbs
- Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Xiao-Cheng Wu
- Louisiana Tumor Registry & Epidemiology and School of Public Health at LSU Health Sciences-New Orleans, New Orleans, Louisiana, USA
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21
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Hershberger PJ, Bricker DA, Conway K, Torcasio MH. Turning "Lose-Lose" into "Win-Win": What Is Good for Them Is Good for Us! MEDICAL SCIENCE EDUCATOR 2021; 31:1177-1181. [PMID: 34457961 PMCID: PMC8368257 DOI: 10.1007/s40670-021-01280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 06/13/2023]
Abstract
Simply telling patients what to do with respect to medical recommendations or lifestyle changes often does not have the desired impact, contributing to frustration for both patients and physicians. Therefore, this "educate and advise" approach can be a "lose-lose" proposition-bad for the patient, and bad for the physician. Broader adoption of efficacious approaches to patient engagement, such as motivational interviewing, can help make the process of addressing patients' behavioral responsibilities regarding chronic disease prevention and management a "win-win" for the health and satisfaction of patients and physicians alike. Greater emphasis on evidence-based patient engagement skills is necessary in medical education.
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Affiliation(s)
- Paul J. Hershberger
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, 725 University Blvd., Dayton, OH USA
| | - Dean A. Bricker
- Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH USA
| | - Katharine Conway
- Department of Family Medicine, Wright State University Boonshoft School of Medicine, 725 University Blvd., Dayton, OH USA
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22
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Hershberger PJ, Martensen LS, Crawford TN, Bricker DA. Promoting Motivational Interviewing in Primary Care: More Than Intention. PRIMER : PEER-REVIEW REPORTS IN MEDICAL EDUCATION RESEARCH 2021; 5:7. [PMID: 33860162 DOI: 10.22454/primer.2021.287928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction Interacting with patients in a manner that furthers self-responsibility for health is an important skill for primary care clinicians. Motivational interviewing (MI) is such an approach to patient engagement, but it remains to be more widely implemented. In a program training health professionals and health professions students in MI, we examined posttraining attitudes and intentions regarding the utilization of MI. Of particular interest was how posttraining intentions were associated with self-reported action 1 month later. Methods We obtained immediate posttraining and 30-day follow-up data from 209 participants regarding intent to utilize the MI approach (self-reported implementation at the follow-up interval), impact on confidence with patient interaction, and perceived importance of the training. We analyzied frequencies and percentages for all categorical/ordinal variables to describe the participants and the survey question responses. Results While 91.5% of participants intended to incorporate MI into their approach with patients (to a moderate or great extent) at posttraining, only 48.7% reported that they had actually implemented the MI approach (to a moderate or great extent) 30 days later. However, another 32.1% indicated that they had occasionally utilized MI. Attitudes toward the importance of MI training and the impact of training on confidence remained strong over the 30 days. Conclusion Achieving more widespread implementation of the MI approach in the primary care setting is likely to be less dependent on convincing clinicians about its importance for patient engagement, but rather on the translation of intent to actual practice and implementation.
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Affiliation(s)
- Paul J Hershberger
- Department of Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Lori S Martensen
- Department of Medical Education, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Timothy N Crawford
- Departments of Population and Public Health Sciences & Family Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
| | - Dean A Bricker
- Department of Internal Medicine, Boonshoft School of Medicine, Wright State University, Dayton, OH
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23
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Vanness DJ, Lomas J, Ahn H. A Health Opportunity Cost Threshold for Cost-Effectiveness Analysis in the United States. Ann Intern Med 2021; 174:25-32. [PMID: 33136426 DOI: 10.7326/m20-1392] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cost-effectiveness analysis is an important tool for informing treatment coverage and pricing decisions, yet no consensus exists about what threshold for the incremental cost-effectiveness ratio (ICER) in dollars per quality-adjusted life-year (QALY) gained indicates whether treatments are likely to be cost-effective in the United States. OBJECTIVE To estimate a U.S. cost-effectiveness threshold based on health opportunity costs. DESIGN Simulation of short-term mortality and morbidity attributable to persons dropping health insurance due to increased health care expenditures passed though as premium increases. Model inputs came from demographic data and the literature; 95% uncertainty intervals (UIs) were constructed. SETTING Population-based. PARTICIPANTS Simulated cohort of 100 000 individuals from the U.S. population with direct-purchase private health insurance. MEASUREMENTS Number of persons dropping insurance coverage, number of additional deaths, and QALYs lost from increased mortality and morbidity, all per increase of $10 000 000 (2019 U.S. dollars) in population treatment cost. RESULTS Per $10 000 000 increase in health care expenditures, 1860 persons (95% UI, 1080 to 2840 persons) were simulated to become uninsured, causing 5 deaths (UI, 3 to 11 deaths), 81 QALYs (UI, 40 to 170 QALYs) lost due to death, and 15 QALYs (UI, 6 to 32 QALYs) lost due to illness; this implies a cost-effectiveness threshold of $104 000 per QALY (UI, $51 000 to $209 000 per QALY) in 2019 U.S. dollars. Given available evidence, there is about 14% probability that the threshold exceeds $150 000 per QALY and about 48% probability that it lies below $100 000 per QALY. LIMITATIONS Estimates were sensitive to inputs, most notably the effects of losing insurance on mortality and of premium increases on becoming uninsured. Health opportunity costs may vary by population. Nonhealth opportunity costs were excluded. CONCLUSION Given current evidence, treatments with ICERs above the range $100 000 to $150 000 per QALY are unlikely to be cost-effective in the United States. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- David J Vanness
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
| | - James Lomas
- University of York, York, United Kingdom (J.L.)
| | - Hannah Ahn
- Pennsylvania State University, University Park, Pennsylvania (D.J.V., H.A.)
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24
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Abstract
Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control trials, a lack of formal theoretical models, and a fear of politics. The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.
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25
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Amianto F, Martini M, Olandese F, Davico C, Abbate-Daga G, Fassino S, Vitiello B. Affectionless control: A parenting style associated with obesity and binge eating disorder in adulthood. EUROPEAN EATING DISORDERS REVIEW 2020; 29:178-192. [PMID: 33247868 DOI: 10.1002/erv.2809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Obesity is rising globally with a heavy health and economic burden. Early attachment experiences are relevant to the development of obesity. The purpose of this study was to investigate if parental care and attachment style experienced in childhood is associated with obesity, with or without binge eating disorder (BED), in adulthood. METHOD Parental style, personality traits, and psychopathology were assessed in 810 clinically referred adults with obesity, of whom 357 with BED and 453 without BED (non-BED), and 463 healthy subjects (HS). Assessments included the Parental Bonding Instrument, Temperament and Character Inventory, Eating Disorder Inventory-2, Symptom Checklist-90 and Beck Depression Inventory-II. RESULTS Both BED and non-BED reported lower maternal and paternal care and higher overprotection than HS. BED reported worse levels of parental care than non-BED and HS. 'Affectionless control' parenting style was more frequently reported by both BED and non-BED than HS. No significant differences in parenting style emerged between BED and non-BED. CONCLUSIONS Perception of parental 'affectionless control' was associated with obesity in adults, and lower quality of parental care was more frequently reported by participants with BED. Parental style may constitute an important target for early interventions to prevent obesity.
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Affiliation(s)
- Federico Amianto
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Matteo Martini
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Francesco Olandese
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Chiara Davico
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Giovanni Abbate-Daga
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Secondo Fassino
- Department of Neurosciences, Psychiatry Section, Regional Pilot Centre for Eating Disorders, University of Torino, Torino, Italy
| | - Benedetto Vitiello
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
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26
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Meadows JL, Shah S, Burg MM, Pfau S, Soufer R. The Foundational Role of Cardiovascular Imaging in the Characterization of Mental Stress-Induced Myocardial Ischemia in Patients with Coronary Artery Disease. Curr Cardiol Rep 2020; 22:162. [PMID: 33037938 DOI: 10.1007/s11886-020-01407-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Mental stress-provoked myocardial ischemia (MSIMI) is an ischemic phenomenon provoked by the experience of psychologically stressful circumstances. While MSIMI was initially identified 50 years ago during activities of daily living through the use of wearable Holter monitor, subsequent research utilized the technologies of cardiac imaging-ventriculography and myocardial perfusion-under controlled conditions to pursue an understanding of pathophysiology and prognosis. This work revealed that MSIMI occurs in almost half of patients with stable coronary artery disease (CAD) and is associated with cardiac events and early mortality. We provide a focused review of the instrumental role that cardiac imaging has played in elucidating how stress affects cardiac physiology and how emerging diagnostic techniques will allow for further research on stress-mediated changes in the coronary macro- and microvasculature. RECENT FINDINGS Observations about the cardiac response to mental stress diverge from underlying cornerstones of the traditional CAD paradigm which is based upon myocardial oxygen demand and the degree of epicardial coronary stenosis. Evidence from studies utilizing non-invasive and invasive studies of coronary perfusion indicates perturbations in the microvascular compartment in response to mental stress. Cardiovascular imaging enjoined with mental stress provocation may be a commanding tool to advance our understanding of non-obstructive CAD and the coronary microvasculature. This further understanding will facilitate incorporation of mental stress testing in the clinical care of patients with discrepant diagnostic work-up of CAD and in patients who experience anginal symptoms due to non-exertional and/or emotional triggers. Such algorithms will be crucial to identify treatment targets to modify the risk associated with mental stress-associated ischemia and adverse prognosis.
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Affiliation(s)
- Judith L Meadows
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Samit Shah
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Matthew M Burg
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Steven Pfau
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Robert Soufer
- Section of Cardiovascular Medicine, Yale School of Medicine, 950 Campbell Ave. / 111B, West Haven, CT, 06516, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
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27
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Frakt AB, Jha AK, Glied S. Pivoting from decomposing correlates to developing solutions: An evidence-based agenda to address drivers of health. Health Serv Res 2020; 55 Suppl 2:781-786. [PMID: 32776528 PMCID: PMC7518812 DOI: 10.1111/1475-6773.13539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Health is influenced by many factors outside the health system. This is often expressed by decomposing contributors to health into factors that sum to 100 percent. In this commentary, we assess the (few) strengths and (many) limitations of such decompositions. We conclude that they fail to be useful for policy guidance. We conclude by proposing an alternative approach to assessing how various factors affect health: evaluations of interventions.
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Affiliation(s)
- Austin B. Frakt
- VA Boston Healthcare SystemBoston University School of Public HealthHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Ashish K. Jha
- Brown University School of Public HealthProvidenceRhode IslandUSA
| | - Sherry Glied
- New York University's Robert F. Wagner Graduate School of Public ServiceNew York CityNew YorkUSA
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28
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Buxbaum JD, Chernew ME, Fendrick AM, Cutler DM. Contributions Of Public Health, Pharmaceuticals, And Other Medical Care To US Life Expectancy Changes, 1990-2015. Health Aff (Millwood) 2020; 39:1546-1556. [PMID: 32897792 DOI: 10.1377/hlthaff.2020.00284] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Life expectancy in the US increased 3.3 years between 1990 and 2015, but the drivers of this increase are not well understood. We used vital statistics data and cause-deletion analysis to identify the conditions most responsible for changing life expectancy and quantified how public health, pharmaceuticals, other (nonpharmaceutical) medical care, and other/unknown factors contributed to the improvement. We found that twelve conditions most responsible for changing life expectancy explained 2.9 years of net improvement (85 percent of the total). Ischemic heart disease was the largest positive contributor to life expectancy, and accidental poisoning or drug overdose was the largest negative contributor. Forty-four percent of improved life expectancy was attributable to public health, 35 percent was attributable to pharmaceuticals, 13 percent was attributable to other medical care, and -7 percent was attributable to other/unknown factors. Our findings emphasize the crucial role of public health advances, as well as pharmaceutical innovation, in explaining improving life expectancy.
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Affiliation(s)
- Jason D Buxbaum
- Jason D. Buxbaum is a student in the Program in Health Policy at Harvard University, in Cambridge, Massachusetts
| | - Michael E Chernew
- Michael E. Chernew is the Leonard D. Schaeffer Professor of Health Care Policy and director of the Healthcare Markets and Regulation (HMR) Lab in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
| | - A Mark Fendrick
- A. Mark Fendrick is a professor in the Department of Internal Medicine and director of the Center for Value-Based Insurance Design at the University of Michigan, in Ann Arbor, Michigan
| | - David M Cutler
- David M. Cutler is the Otto Eckstein Professor of Applied Economics in the Department of Economics at Harvard University and a research associate at the National Bureau of Economic Research, in Cambridge, Massachusetts
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29
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Abstract
Although research on alcohol-related disparities among women is a highly understudied area, evidence shows that racial/ethnic minority women, sexual minority women, and women of low socioeconomic status (based on education, income, or residence in disadvantaged neighborhoods) are more likely to experience alcohol-related problems. These problems include alcohol use disorder, particularly after young adulthood, and certain alcohol-related health, morbidity, and mortality outcomes. In some cases, disparities may reflect differences in alcohol consumption, but in other cases such disparities appear to occur despite similar and possibly lower levels of consumption among the affected groups. To understand alcohol-related disparities among women, several factors should be considered. These include age; the duration of heavy drinking over the life course; the widening disparity in cumulative socioeconomic disadvantage and health in middle adulthood; social status; sociocultural context; genetic factors that affect alcohol metabolism; and access to and quality of alcohol treatment services and health care. To inform the development of interventions that might mitigate disparities among women, research is needed to identify the factors and mechanisms that contribute most to a group's elevated risk for a given alcohol-related problem.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Kara M Bensley
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Najmabadi S, Honda TJ, Hooker RS. Collaborative practice trends in US physician office visits: an analysis of the National Ambulatory Medical Care Survey (NAMCS), 2007-2016. BMJ Open 2020; 10:e035414. [PMID: 32565462 PMCID: PMC7311045 DOI: 10.1136/bmjopen-2019-035414] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Practice arrangements in physician offices were characterised by examining the share of visits that involved physician assistants (PAs) and nurse practitioners (NPs). The hypothesis was that collaborative practice (ie, care delivered by a dyad of physician-PA and/or physician-NP) was increasing. DESIGN Temporal ecological study. SETTING Non-federal physician offices. PARTICIPANTS Patient visits to a physician, PA or NP, spanning years 2007-2016. METHODS A stratified random sample of visits to office-based physicians was pooled through the National Ambulatory Medical Care Survey public use linkage file. Among 317 674 visits to physicians, PAs or NPs, solo and collaborative practices were described and compared over two timespans of 2007-2011 and 2012-2016. Weighted patient visits were aggregated in bivariate analyses to achieve nationally representative estimates. Survey statistics assessed patient demographic characteristics, reason for visit and visit specialty by provider type. RESULTS Within years 2007-2011 and 2012-2016, there were 4.4 billion and 4.1 billion physician office visits (POVs), respectively. Comparing the two timespans, the rate of POVs with a solo PA (0.43% vs 0.21%) or NP (0.31% vs 0.17%) decreased. Rate of POVs with a collaborative physician-PA increased non-significantly. Rate of POVs with a collaborative physician-NP (0.49% vs 0.97%, p<0.01) increased. Overall, collaborative practice, in particular physician-NP, has increased in recent years (p<0.01), while visits handled by a solo PA or NP decreased (p<0.01). In models adjusted for patient age and chronic conditions, the odds of collaborative practice in years 2012-2016 compared with years 2007-2011 was 35% higher (95% CI 1.01 to 1.79). Furthermore, in 2012-2016, NPs provided more independent primary care, and PAs provided more independent care in a non-primary care medical specialty. Preventive visits declined among all providers. CONCLUSIONS In non-federal physician offices, collaborative care with a physician-PA or physician-NP appears to be a growing part of office-based healthcare delivery.
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Affiliation(s)
- Shahpar Najmabadi
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
| | - Trenton J Honda
- Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah, USA
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Cronin CE, Franz B, Schuller KA. Expanding the Population Health Workforce: Strategic Priorities of Hospital Organizations in the United States. Popul Health Manag 2020; 24:59-68. [PMID: 32155088 DOI: 10.1089/pop.2019.0138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The role of hospital contributions to population health is a topic increasingly worthy of attention in the years since the Affordable Care Act. To explore how hospitals themselves consider their role as population health leaders, the authors analyzed data from the 2015 American Hospital Association Annual Population Health Survey, which asks organizations about which strategic priorities should be expanded in order to strengthen their organization's population health workforce. Descriptive statistics for the study sample of 1418 hospitals show that physicians were the most commonly ranked priority, followed by behavioral health professionals. Using multivariate analysis, the professional roles identified were grouped into 5 categories: behavioral health, clinical, data collection, business functions, and social supports and services. Doing so revealed that different types of hospitals were more likely to identify different types of roles as more important. Larger hospitals were more likely than others to identify behavioral health and clinical roles. For-profit hospitals were less likely to prioritize data collection and social determinants than their nonprofit peers. These findings provide important insight for public health professionals regarding the staffing priorities of hospitals within their communities. Many population health programs may not be moving beyond traditional clinical expertise to engage the upstream determinants of health in their communities.
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Affiliation(s)
- Cory E Cronin
- College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
| | - Berkeley Franz
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Kristin A Schuller
- College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA
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Hoffer EP. The American Health Care System Is Broken. Part 7: How Can We Fix It? Am J Med 2019; 132:1381-1385. [PMID: 31668898 DOI: 10.1016/j.amjmed.2019.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
Abstract
Previous articles have outlined the many problems that confront America in trying to humanely and efficiently deliver health care to our citizens. First among these is that health care is unaffordable for too many. This final article describes how to expand coverage to all Americans and identifies many specific areas in which changes can be made to both improve care and lower costs. There are many ways to reduce the cost of medications, to improve hospital care while lowering costs, to eliminate "surprise" medical bills, and to cut down fraud and waste. The socioeconomic factors that contribute heavily to our poor health outcomes must be addressed.
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Affiliation(s)
- Edward P Hoffer
- Associate Professor of Medicine, part-time, Harvard, Cambridge, Mass; Laboratory of Computer Science, Massachusetts General Hospital, Boston.
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Gérvas J, Oliver LL, Pérez-Fernandez M. Family and Community Medicine and its role in preventing health overuse (preventive, diagnostic, therapeutic and rehabilitative). CIENCIA & SAUDE COLETIVA 2019; 25:1233-1240. [PMID: 32267426 DOI: 10.1590/1413-81232020254.30082019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 10/23/2019] [Indexed: 11/22/2022] Open
Abstract
In Medicine, it is critical "to offer 100% of what is needed and avoid 100% of what is not needed." Unfortunately, this primary issue is challenging, and generally, more than required is offered, and everything that is unnecessary is not avoided. This is a nonsystematic review with a teaching objective that reviews the general issue in primary care and suggests ways to avoid overuse and shortcomings concerning preventive, diagnostic, therapeutic, and rehabilitative interventions. Knowing not to do is science and art that is hardly taught and practiced less. The overuse that harm are an almost daily part of clinical practice in prevention, diagnosis, treatment, and rehabilitation. It is essential to promote "the art and science of not doing".
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Affiliation(s)
- Juan Gérvas
- Equipo CESCA. Pradillo 68.28002 Madrid España.
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Warren GW, Wang K, Goldstein AO. Smoking Cessation and Low-Dose Computed Tomography Screening: A Necessary Pair. J Thorac Oncol 2019; 14:1495-1497. [DOI: 10.1016/j.jtho.2019.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 11/26/2022]
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Woolf SH. Necessary But Not Sufficient: Why Health Care Alone Cannot Improve Population Health and Reduce Health Inequities. Ann Fam Med 2019; 17:196-199. [PMID: 31085522 PMCID: PMC6827630 DOI: 10.1370/afm.2395] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Steven H Woolf
- Department of Family Medicine and Population Health and Center on Society and Health, Virginia Commonwealth University, Richmond, Virgina
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