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Penwell TE, Bedard SP, Eyre R, Levinson CA. Eating Disorder Treatment Access in the United States: Perceived Inequities Among Treatment Seekers. Psychiatr Serv 2024; 75:944-952. [PMID: 38716514 DOI: 10.1176/appi.ps.20230193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024]
Abstract
OBJECTIVE Although eating disorders are associated with high rates of psychological and physical impairments and mortality, only about 20% of individuals with eating disorders receive treatment. No study has comprehensively assessed treatment access for those with these disorders in the United States. The authors examined access to eating disorder treatments and how it might vary among some populations. METHODS Seekers of treatment for eating disorders (N=1,995) completed an online assessment of clinical demographic and anthropometric characteristics, barriers to eating disorder treatment access, and eating disorder symptomatology. Analyses were conducted to identify treatment access barriers, compare barriers to treatment access across demographic groups, and investigate relationships between barriers to treatment access and eating disorder symptoms. RESULTS Financial barriers (e.g., lack of insurance coverage) were the most frequently reported barrier to treatment access. Participants with historically underrepresented identities and with a diagnosis of other specified feeding or eating disorder (OSFED) reported more barriers related to financial challenges, geographic location, eating disorder identification, sociocultural factors, and treatment quality compared with those with historically represented identities (e.g., White and cisgender persons). Higher frequencies of reported barriers to treatment access were associated with more severe eating disorder symptoms and poorer illness trajectories. CONCLUSIONS Financial barriers were the most significant impediment to accessing treatment among individuals seeking eating disorder treatment. Barriers to treatment access disproportionally affected underrepresented groups and those with an OSFED diagnosis.
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Affiliation(s)
- Taylor E Penwell
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Samantha P Bedard
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Rebecca Eyre
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
| | - Cheri A Levinson
- Department of Psychological and Brain Sciences, University of Louisville, Louisville (Penwell, Levinson); Department of Psychology, University of Wyoming, Laramie (Bedard); Project HEAL, New York City (Eyre)
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Crawford AD, Testa A, Darilek U, Howe R, McGrath JM, Shlafer R. Perinatal Health Outcomes Among Women on Community Supervision: A Scoping Review. JOURNAL OF CORRECTIONAL HEALTH CARE 2024; 30:245-256. [PMID: 38985685 DOI: 10.1089/jchc.23.09.0073] [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] [Indexed: 07/12/2024]
Abstract
The purpose of this scoping review is to review the extant literature regarding perinatal health outcomes for women on community supervision in the United States. PubMed, CINAHL, Scopus, PsycINFO, and Public Health were searched for peer-reviewed articles published in the United States from January 1, 1970, to March 7, 2023. After removal of duplicates and review of 1,412 article titles and abstracts, 19 articles were retrieved for full-text review; this yielded 4 studies for inclusion. Studies range in size from 10 to 292 participants (N = 405) and only two reported geographic locations. Three studies comprised probation or parole and two studies included court-mandated treatment for substance use. All studies examined outcomes during the postpartum period, such as mood disorder or substance use severity. No studies evaluated the health of women during pregnancy and/or childbirth. To enhance health equity and reduce maternal morbidity and mortality among women on community supervision, more inclusive research that examines health outcomes during the perinatal period is needed. Furthermore, there must be interventions that address the social determinants of health, racial and systemic discrimination, socioeconomic barriers, and violence that are often experienced among women with criminal justice system involvement.
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Affiliation(s)
- Allison D Crawford
- School of Nursing, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Alexander Testa
- School of Public Health, University of Texas Health at Houston, Houston, Texas, USA
| | - Umber Darilek
- Department of Pediatrics, School of Medicine, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Rebecca Howe
- Briscoe Library, School of Health Professions, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Jacqueline M McGrath
- School of Nursing, University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Rebecca Shlafer
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Weeks WB, Chang JE, Pagán JA, Adamson E, Weinstein J, Ferres JML. The Ecology of Economic Distress and Life Expectancy. Int J Public Health 2024; 69:1607295. [PMID: 39132383 PMCID: PMC11309997 DOI: 10.3389/ijph.2024.1607295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
Objectives To determine whether life expectancy (LE) changes between 2000 and 2019 were associated with race, rural status, local economic prosperity, and changes in local economic prosperity, at the county level. Methods Between 12/1/22 and 2/28/23, we conducted a retrospective analysis of 2000 and 2019 data from 3,123 United States counties. For Total, White, and Black populations, we compared LE changes for counties across the rural-urban continuum, the local economic prosperity continuum, and for counties in which local economic prosperity dramatically improved or declined. Results In both years, overall, across the rural-urban continuum, and for all studied populations, LE decreased with each progression from the most to least prosperous quintile (all p < 0.001); improving county prosperity between 2000-2019 was associated with greater LE gains (p < 0.001 for all). Conclusion At the county level, race, rurality, and local economic distress were all associated with LE; improvements in local economic conditions were associated with accelerated LE. Policymakers should appreciate the health externalities of investing in areas experiencing poor economic prosperity if their goal is to improve population health.
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Affiliation(s)
| | - Ji E. Chang
- School of Global Public Health, New York University, New York, NY, United States
| | - José A. Pagán
- School of Global Public Health, New York University, New York, NY, United States
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Johnson C, Ingraham MK, Stafford SR, Guilamo-Ramos V. Adopting a nurse-led model of care to advance whole-person health and health equity within Medicaid. Nurs Outlook 2024; 72:102191. [PMID: 38781773 DOI: 10.1016/j.outlook.2024.102191] [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: 01/16/2024] [Revised: 04/18/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Medicaid payment reforms and delivery model innovations are needed to fully transform U.S. healthcare structuring and provision. PURPOSE To synthesize nurse-led models of care and their implications for improving health care access, quality, and reducing costs for Medicaid recipients. METHODS A critical review of the literature regarding nurse-led models and implications for addressing social determinants of health (SDOH), adopting population health approaches, managing complex care, and integrating behavioral and physical health care within Medicaid. DISCUSSION Three interrelated findings emerged (a) investing in dynamic nurse-led models is important for mitigating SDOH and adopting value-based care, (b) regulations preventing nurses from practicing at the fullest extent of their training and licensure limit clinical impact and value, and (c) directed payments can establish value-based expectations for Medicaid managed care. CONCLUSION Adoption of a nurse-led model of care has the potential to advance the goals of reducing inequity and promoting whole-person health within Medicaid and nationally.
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Affiliation(s)
- Celia Johnson
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD
| | | | - Stephen R Stafford
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD
| | - Vincent Guilamo-Ramos
- Institute for Policy Solutions, Johns Hopkins School of Nursing, Washington, DC; Center for Latino Adolescent and Family Health, Johns Hopkins School of Nursing, Baltimore, MD; Presidential Advisory Council on HIV/AIDS, U.S. Department of Health and Human Services, Washington, DC.
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Balamuthusamy S, Dhanabalsamy N, Thankavel B, Bala MS, Pfaffle A. Utility of a ML analytics on real time risk stratification and re-intervention risk prediction on AV access outcomes and cost. J Vasc Access 2024; 25:1224-1228. [PMID: 36847187 DOI: 10.1177/11297298231156632] [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] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Vascular access is the lifeline for patients on hemodialysis. The average survival rates of dialysis dependent patients have been improving over the last 5 years and hence their dialysis access needs longevity for uninterrupted optimal dialysis. With the lack of genomic vascular access failure predictors, there is an unmet need for predicting an event and the appropriate approach to mitigate recurrence of the event that could have cost and outcome implications. METHODS We performed a single center experience that extracted relevant clinical (access flow, laboratory data and CKD details), access intervention (prior interventions, type & location of lesion, type of balloon used, use of stents etc.) and demographic (age, vintage on dialysis, sex, social determinants, other medical conditions) data in real time and feeds it into validated ML algorithms to predict risk of reintervention. (Plexus EMR LLC). RESULTS About 200 prevalent hemodialysis patients with a AV graft or AV fistula were included for this analysis. Need for re-intervention and use of stent/ flow reduction/new access creation were the outcomes analyzed. Plexus EMR is a licensed Azure based platform. R software was used to develop the ML algorithms. Regression factors were developed to assess and test the validity of individual attributes across all the data attributes. Each patient had a real time risk calculator available to the interventionalist on risk of reintervention/ year. Of the 200 patients, 148 had a AV fistula and the remaining 52 had a AV graft. Mean interventions in the year prior to analysis was 1.8 in patients with AV fistulas and 3.4 in AV grafts which decreased to 1.1 in AV fistulas and to 2.4 in AV grafts (p < 0.01) post tool deployment. There were 62 AV graft thrombectomies done in the observation year and 62% of those were repeat thrombectomies. Stent utilization increased to 37 (22 in AV grafts and 15 in AV fistulas) and 2 patients had AV access flow reduction surgery. The cumulative cost (predicted) preintervention was $712,609 and decreased to $512,172 post intervention. Stent utilization increased by 68% in the evaluation year and 89% of the stents used were PTFE coated stents. CONCLUSION Utilizing AI with ML based algorithms that includes clinical, demographic and patency maintenance variables could become new standards of care to optimally manage AV accesses and lower cost of care.
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Affiliation(s)
- Saravanan Balamuthusamy
- PPG Health PA and Tarrant Vascular, Fort Worth, TX, USA
- Texas Research Institute, Fort Worth, TX, USA
- HCA Healthcare, Fort Worth, TX, USA
- Plexus EMR LLC, Dallas, TX, USA
- OptMyCare Inc, Fort Worth, TX, USA
| | | | - Bharath Thankavel
- HCA Healthcare, Fort Worth, TX, USA
- OptMyCare Inc, Fort Worth, TX, USA
| | - Manu S Bala
- Texas Research Institute, Fort Worth, TX, USA
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Raymond T, Johnson J, Hogans-Mathews S. Evaluating the Prevalence of Maternal Health Indicators on Infant Mortality Rates in Florida. Cureus 2024; 16:e63539. [PMID: 39086786 PMCID: PMC11290385 DOI: 10.7759/cureus.63539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/30/2024] [Indexed: 08/02/2024] Open
Abstract
Background The infant mortality rate is defined as the number of infant deaths for every 1000 live births. In 2020, the infant mortality rate was 5.8% in the state of Florida, compared to 7.0% in 2000. Although infant mortality rates have declined in the state of Florida, disparities influencing these rates exist across varying Florida counties, with the widest differences being compared between the healthiest versus unhealthiest counties in Florida. Many factors can contribute to high infant mortality rates in certain counties, including income inequality, access to and quality of healthcare, race/ethnicity, obesity, and disadvantaged socioeconomic status (SES). Methods This study utilized data from Florida Health Charts on infant mortality rates in the state of Florida and the Pregnancy and Young Child Profiles in 10 counties to examine how certain risk factors impact infant mortality outcomes in the state of Florida. These 10 counties consist of five healthiest and five unhealthiest counties, as determined by the 2022 County Health Rankings data. T-tests were used to evaluate the relationship between county health status and several county health indicators. Results The average infant mortality rate from 2011 to 2020 differed significantly among healthy and unhealthy counties (p-value=0.0000). Median household income, individuals below the poverty level, and those aged zero to 17 years old were found to differ significantly by county health status (p-values 0.0000, 0.001, and 0.009, respectively). However, mothers having no high school education, births with first-trimester care, births with adequate care, and births with late or no prenatal care were not statistically significant. Conclusion Our study suggests that counties more likely to have fewer resources than other counties, such as those considered unhealthy, are more impacted by a higher infant mortality rate. The unhealthy counties in this study were found to have lower average median household income, higher rates of no high school education among mothers, and less prenatal care in comparison to healthy counties.
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Affiliation(s)
- Tamara Raymond
- College of Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Jane Johnson
- Health Policy, Florida Association of Centers for Independent Living, Tallahassee, USA
| | - Shermeeka Hogans-Mathews
- Family Medicine and Rural Health, Florida State University College of Medicine, Tallahassee, USA
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Rea CJ, Toomey SL, Hauptman M, Rosen M, Samuels RC, Karpowicz K, Flanagan S, Shah SN. Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic. Clin Pediatr (Phila) 2024; 63:512-521. [PMID: 37309813 PMCID: PMC10863332 DOI: 10.1177/00099228231179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.
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Affiliation(s)
- Corinna J. Rea
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sara L. Toomey
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Marissa Hauptman
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Melissa Rosen
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Ronald C. Samuels
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of General Pediatrics, The Children’s Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Shelby Flanagan
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
| | - Snehal N. Shah
- Division of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ventres WB, Stone LA, Gibson-Oliver LE, Meehan EK, Ricker MA, Loxterkamp D, Ogbeide SA, deGruy FV, Mahoney MR, Lin S, MacRae C, Mercer SW. Storylines of family medicine VIII: clinical approaches. Fam Med Community Health 2024; 12:e002795. [PMID: 38609085 PMCID: PMC11029325 DOI: 10.1136/fmch-2024-002795] [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] [Indexed: 04/14/2024] Open
Abstract
Storylines of Family Medicine is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'VIII: clinical approaches', authors address the following themes: 'Evaluation, diagnosis and management I-toward a working diagnosis', 'Evaluation, diagnosis and management II-process steps', 'Interweaving integrative medicine and family medicine', 'Halfway-the art of clinical judgment', 'Seamless integration in family medicine-team-based care', 'Technology-uncovering stories from noise' and 'Caring for patients with multiple long-term conditions'. May readers recognise in these essays the uniqueness of a family medicine approach to care.
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Affiliation(s)
- William B Ventres
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Leslie A Stone
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Lauren E Gibson-Oliver
- Family and Preventive Medicine, University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA
| | - Elizabeth Kyle Meehan
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | - Mari A Ricker
- Family and Community Medicine, The University of Arizona College of Medicine - Tucson, Tucson, Arizona, USA
| | | | - Stacy A Ogbeide
- Family and Community Medicine, UT Health San Antonio Long School of Medicine, San Antonio, Texas, USA
| | - Frank V deGruy
- Eugene S. Farley, Jr. Health Policy Center, University of Colorado Anschutz Medical Campus School of Medicine, Aurora, Colorado, USA
| | - Megan R Mahoney
- Family and Community Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Steven Lin
- Division of Primary Care and Population Health, Stanford Medicine, Palo Alto, California, USA
| | - Clare MacRae
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
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Coles DC, Sawyer J, Perkins NH. Understanding the Behavioral Health Risk Factors that African American and Latinx Women Experience within a National Context. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:284-296. [PMID: 38459933 DOI: 10.1080/19371918.2024.2323142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
In an effort to address social determinants of health and to reduce barriers to care, there have been increased attempts to understand and mitigate public health concerns in ethnic minority communities. As knowledge increases regarding the impact of health disparities on ethnic minority communities, social workers practice knowledge must expand to include intersectional approaches and methods that are inclusive of mechanisms that address inconsistencies in access to health care. Using the 2018 National Survey on Drug Use and Health (NSDUH), this study examined behavioral health and psychosocial risk factors that African American and Latinx women (n = 7008) experienced and identified how these factors are associated with self-reported overall health. Results indicated that overall health and wellbeing is linked to psychosocial risk factors, such as depression, substance use, and even age for African American and Latinx women.
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Affiliation(s)
- D Crystal Coles
- School of Social Work, Morgan State University, Arlington, VA
| | - Jason Sawyer
- Department of Counseling and Human Services, Old Dominion University, Arlington, VA
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Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
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Serchen J, Hilden DR, Beachy MW. Meeting the Health and Social Needs of America's Unhoused and Housing-Unstable Populations: A Position Paper From the American College of Physicians. Ann Intern Med 2024; 177:514-517. [PMID: 38408358 DOI: 10.7326/m23-2795] [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: 02/28/2024] Open
Abstract
Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | | | - Micah W Beachy
- Nebraska Medicine-University of Nebraska Medical Center, Omaha, Nebraska (M.W.B.)
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Ginzberg SP, Kalva S, Wirtalla CJ, Passman JE, Cohen DL, Cohen JB, Wachtel H. Development of a risk-prediction model for primary aldosteronism in veterans with hypertension. Surgery 2024; 175:73-79. [PMID: 37867108 PMCID: PMC10845130 DOI: 10.1016/j.surg.2023.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/18/2023] [Accepted: 04/27/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Rates of screening for primary aldosteronism in patients who meet the criteria are exceedingly low (1%-3%). To help clinicians prioritize screening in patients most likely to benefit, we developed a risk-prediction model. METHODS Using national Veterans Health Administration data, we identified patients who met the criteria for primary aldosteronism screening between 2000 and 2019. We performed multivariable logistic regression to identify characteristics associated with positive primary aldosteronism testing before generating a risk-scoring system based on the coefficients (0< β < 0.5 = 1 pt, 0.5 ≤ β < 1 = 2 pts, 1 ≤ β < 1.5 = 3 pts) and then tested the system performance using an internal validation cohort. RESULTS We identified 502,190 patients who met primary aldosteronism screening criteria, of whom 1.6% were screened and 15% tested positive. Based on the regression model, we generated a risk-scoring system based on a total of 9 possible points in which age under 50, absence of smoking history, and resistant hypertension each scored 1 point; elevated serum sodium 2 points; and hypokalemia 3 points. Rates of positive screening increased with risk score, with 5.6% to 6.7% of those scoring 0 points testing positive; 7.9% to 9.0% 1 point; 8.6% to 10% 2 points; 13% to 14% 3 points; 21% 4 points; 22% to 38% 5 points; 27% to 38% 6 points; 42% to 49% 7 points; and 50% to 51% ≥8 points. CONCLUSION In hypertensive patients who meet the criteria for primary aldosteronism screening, rates of positive screening range from 5.6% to 51%. Use of our risk-predication model incorporating these factors can identify patients most likely to benefit from testing.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA.
| | - Saiesh Kalva
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | | | - Jesse E Passman
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Debbie L Cohen
- Department of Medicine, Division of Renal-Electrolyte and Hypertension, University of Pennsylvania Health System, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jordana B Cohen
- Department of Medicine, Division of Renal-Electrolyte and Hypertension, University of Pennsylvania Health System, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. https://twitter.com/jordy_bc
| | - Heather Wachtel
- Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Adams AM, Arrazola J, Daly ER, Tompkins M. Threat Agnostic Epidemiology and Surveillance in US Public Health Agencies: Future Potential and Needs. Health Secur 2024; 22:25-30. [PMID: 38079238 DOI: 10.1089/hs.2023.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Affiliation(s)
- Andrew M Adams
- Andrew M. Adams, MPH, is a Senior Program Analyst, Preparedness and Response; the Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Jessica Arrazola
- Jessica Arrazola, DrPH, MPH, MCHES, is Director of Educational Strategy; the Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Elizabeth R Daly
- Elizabeth R. Daly, DrPH, MPH, is Director of Infectious Disease Programs; the Council of State and Territorial Epidemiologists, Atlanta, GA
| | - Megan Tompkins
- Megan Tompkins, MPH, is Data Modernization Implementation Lead; the Council of State and Territorial Epidemiologists, Atlanta, GA
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Katzman JG, Gallagher RM. Pain: The Silent Public Health Epidemic. J Prim Care Community Health 2024; 15:21501319241253547. [PMID: 38742616 PMCID: PMC11095171 DOI: 10.1177/21501319241253547] [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: 01/03/2024] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
More than 50 million Americans suffer from chronic pain, costing our society an estimated 565 to 635 billion dollars annually. Its complexity and training deficits in healthcare providers result in many patients receiving ineffective care. Large health inequities also exist in access to effective pain care for vulnerable populations. The traumatic history of indigenous people and people of color in regards to the experience of pain care perpetuates a lack of trust in the healthcare system, causing many to hesitate to seek medical treatment for painful events and conditions. Other vulnerable populations include those with sickle cell disease or fibromyalgia, whose experience of pain has not been well-understood. There are both barriers to care and stigma for patients with pain, including those taking prescribed doses of long-term opioids, those with known substance use disorder, and those with mental health diagnoses. The suffering of patients with pain can be "invisible" to the clinician, and to one's community at large. Pain can affect all people; but those most vulnerable to not getting effective care may continue to suffer in silence because their voices are not heard. Since 1973, pain societies around the globe have worked tirelessly to bring clinicians together to advance pain and opioid education, research, and patient care. These improvements consist of pain education, integrative treatment, and the understanding that a therapeutic alliance is critical to effective pain management. Pain education for both pre and post-licensure health professionals has increased substantially over the last decade. In addition, integrative and interdisciplinary approaches for clinical pain management are now considered best practices in pain care for patients with moderate to severe pain in addition to the development of a strong therapeutic alliance.
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Affiliation(s)
- Joanna G. Katzman
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Department of Neurosurgery, University of New Mexico, Albuquerque, USA
- Public Health Initiatives Project ECHO, Albuquerque, USA
| | - Rollin Mac Gallagher
- American Academy of Pain Medicine, Chicago, IL, USA
- Center for Health Equities Research and Promotion (CHERP), Michael J Crescenz VA Medical Center, Philadelphia, USA
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15
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O'Hara HM. The Work, Play, and Worship Environments as Social Determinants of Health. Prim Care 2023; 50:621-631. [PMID: 37866835 DOI: 10.1016/j.pop.2023.04.009] [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] [Indexed: 10/24/2023]
Abstract
Consideration of the definition of the social determinants of health (SDOHs) requires health care to include work, play, and worship environments because they are important to the health of patients and communities. This article attempts to discuss the issues with limited focus on these areas and the importance of using multidisciplinary health-care teams during primary care visits. The expectation from this information is to advance the ability for primary care providers to support patients and the communities they work in to effect change toward decreasing health disparities and enhancing overall health outcomes.
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Affiliation(s)
- Heather M O'Hara
- Memorial Occupational Health Clinic, 2120 North 27th Street, Decatur, IL 62526, USA.
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16
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Reddy MS, D'Souza RN, Webster-Cyriaque J. A Call for More Oral Health Research in Primary Care. JAMA 2023; 330:1629-1630. [PMID: 37934228 DOI: 10.1001/jama.2023.22005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Michael S Reddy
- UCSF School of Dentistry, Oral Health Affairs, University of California, San Francisco
| | - Rena N D'Souza
- National Institute of Dental and Craniofacial Research, Section on Craniofacial Genetic Disorders, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Webster-Cyriaque
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland
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17
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Dahal A, Kardonsky K, Cunningham M, Evans DV, Keys T. The Effect of Rural Underserved Opportunities Program Participation on Medical Graduates' Decision to Work in Rural Areas. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1288-1293. [PMID: 36724293 DOI: 10.1097/acm.0000000000005162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE There is a persistent rural physician shortage in the United States. Policies to scale up the health workforce in response to this shortage must include measures to draw and maintain existing and newly trained health care workers to rural regions. Prior studies have found that experience in community medicine in rural practice settings increases the likelihood of medical graduates practicing in those regions but have not accounted for selection bias. This study examined the impact of a community-based clinical immersion program on medical graduates' decision to work in rural regions, adjusting for covariates to control for selection bias. METHOD Data on sociodemographic characteristics and career interests and preferences for all 1,172 University of Washington School of Medicine graduates between 2009 and 2014 were collected. A logistic model (model 1) was used to evaluate the impact of Rural Underserved Opportunities Program (RUOP) participation on the probability of physicians working in a rural region. Another model (model 2) included the propensity score as a covariate in the regression to control for possible confounding based on differences among those who did and did not participate in the RUOP. RESULTS Of the 994 students included in the analysis, 570 (57.3%) participated in RUOP training, and 111 (11.2%) were currently working in rural communities after their training. Regression analysis results showed that the odds of working in a rural region were 1.83 times higher for graduates who participated in RUOP in model 1 ( P = .03) and 1.77 times higher in model 2 ( P = .04). CONCLUSIONS The findings of this study emphasize that educational programs and policies are crucial public health interventions that can promote health equity through proper distribution of health care workers across rural regions of the United States.
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Affiliation(s)
- Arati Dahal
- A. Dahal is a research scientist, Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Kim Kardonsky
- K. Kardonsky is assistant professor, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Matthew Cunningham
- M. Cunningham is assistant professor, Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - David V Evans
- D.V. Evans is professor, Department of Family Medicine, University of Washington, Seattle, Washington
| | - Toby Keys
- T. Keys is assistant teaching professor, Department of Family Medicine, University of Washington, Seattle, Washington
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18
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Rao M, Greene L, Nelson K, Maciejewski ML, Zulman DM. Associations Between Social Risks and Primary Care Utilization Among Medically Complex Veterans. J Gen Intern Med 2023; 38:3339-3347. [PMID: 37369890 PMCID: PMC10682359 DOI: 10.1007/s11606-023-08269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Social risks contribute to poor health outcomes, especially for patients with complex medical needs. These same risks may impact access to primary care services. OBJECTIVE To study associations between social risks and primary care utilization among patients with medical complexity. DESIGN Prospective cohort study of respondents to a 2018 mailed survey, followed up to 2 years after survey completion. PARTICIPANTS Nationally representative sample of 10,000 primary care patients in the Veterans Affairs (VA) health care system, with high (≥ 75th percentile) 1-year risk of hospitalization or death. MAIN MEASURES Survey-based exposures were low social support, no family member/friend involved in health care, unemployment, transportation problem, food insecurity, medication insecurity, financial strain, low medical literacy, and less than high school graduate. Electronic health record-based outcomes were number of primary care provider (PCP) encounters, number of primary care team encounters (PCP, nurse, clinical pharmacist, and social worker), and having ≥ 1 social work encounter. KEY RESULTS Among 4680 respondents, mean age was 70.3, 93.7% were male, 71.8% White non-Hispanic, and 15.8% Black non-Hispanic. Unemployment was associated with fewer PCP and primary care team encounters (incident rate ratio 0.77, 95% CI 0.65-0.91; p = 0.002 and 0.75, 0.59-0.95; p = 0.02, respectively), and low medical literacy was associated with more primary care team encounters (1.17, 1.05-1.32; p = 0.006). Among those with one or more social risks, 18.4% had ≥ 1 social work encounter. Low medical literacy (OR 1.95, 95% CI 1.45-2.61; p < 0.001), transportation problem (1.42, 1.10-1.83; p = 0.007), and low social support (1.31, 1.06-1.63; p = 0.01) were associated with higher odds of ≥ 1 social work encounter. CONCLUSIONS We found few differences in PCP and primary care team utilization among medically complex VA patients by social risk. However, social work use was low, despite its central role in addressing social risks. More work is needed to understand barriers to social work utilization.
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Affiliation(s)
- Mayuree Rao
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA.
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA.
| | - Liberty Greene
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Karin Nelson
- Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, USA
- General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Maciejewski
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA
- Department of Population Health Sciences, Duke University, Durham, NC, USA
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Donna M Zulman
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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19
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Weeks WB, Chang JE, Pagán JA, Lumpkin J, Michael D, Salcido S, Kim A, Speyer P, Aerts A, Weinstein JN, Lavista JM. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002420. [PMID: 37788228 PMCID: PMC10547156 DOI: 10.1371/journal.pgph.0002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023]
Abstract
While rural-urban disparities in health and health outcomes have been demonstrated, because of their impact on (and intervenability to improve) health and health outcomes, we sought to examine cross-sectional and longitudinal inequities in health, clinical care, health behaviors, and social determinants of health (SDOH) between rural and non-rural counties in the pre-pandemic era (2015 to 2019), and to present a Health Equity Dashboard that can be used by policymakers and researchers to facilitate examining such disparities. Therefore, using data obtained from 2015-2022 County Health Rankings datasets, we used analysis of variance to examine differences in 33 county level attributes between rural and non-rural counties, calculated the change in values for each measure between 2015 and 2019, determined whether rural-urban disparities had widened, and used those data to create a Health Equity Dashboard that displays county-level individual measures or compilations of them. We followed STROBE guidelines in writing the manuscript. We found that rural counties overwhelmingly had worse measures of SDOH at the county level. With few exceptions, the measures we examined were getting worse between 2015 and 2019 in all counties, relatively more so in rural counties, resulting in the widening of rural-urban disparities in these measures. When rural-urban gaps narrowed, it tended to be in measures wherein rural counties were outperforming urban ones in the earlier period. In conclusion, our findings highlight the need for policymakers to prioritize rural settings for interventions designed to improve health outcomes, likely through improving health behaviors, clinical care, social and environmental factors, and physical environment attributes. Visualization tools can help guide policymakers and researchers with grounded information, communicate necessary data to engage relevant stakeholders, and track SDOH changes and health outcomes over time.
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Affiliation(s)
- William B. Weeks
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Ji E. Chang
- School of Global Public Health, New York University, New York, New York, United States of America
| | - José A. Pagán
- School of Global Public Health, New York University, New York, New York, United States of America
| | - Jeffrey Lumpkin
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Divya Michael
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Santiago Salcido
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | - Allen Kim
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - James N. Weinstein
- Microsoft Research, Microsoft Corporation, Redmond, Washington, United States of America
- The Dartmouth Institute and Tuck School of Business, Dartmouth College, Hanover, New Hampshire, United States of America
- Kellogg School of Business, Northwestern University, Evanston, Illinois, United States of America
| | - Juan M. Lavista
- AI for Good Lab, Microsoft Corporation, Redmond, Washington, United States of America
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20
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Cook RR, Jaworski EN, Hoffman KA, Waddell EN, Myers R, Korthuis PT, Vergara-Rodriguez P. Treatment Initiation, Substance Use Trajectories, and the Social Determinants of Health in Persons Living With HIV Seeking Medication for Opioid Use Disorder. Subst Abus 2023; 44:301-312. [PMID: 37842910 PMCID: PMC10830143 DOI: 10.1177/08897077231200745] [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: 10/17/2023]
Abstract
BACKGROUND People living with HIV and opioid use disorder (OUD) are disproportionally affected by adverse socio-structural exposures negatively affecting health, which have shown inconsistent associations with uptake of medications for OUD (MOUD). This study aimed to determine whether social determinants of health (SDOH) were associated with MOUD uptake and trajectories of substance use in a clinical trial of people seeking treatment. METHODS Data are from a 2018 to 2019 randomized trial comparing the effectiveness of different MOUD to achieve viral suppression among people living with HIV and OUD. SDOH were defined by variables mapping to Healthy People 2030 domains: education (Education Access and Quality), income (Economic Stability), homelessness (Neighborhood and Built Environment), criminal justice involvement (Social and Community Context), and recent SUD care (Health Care Access and Quality). Associations between SDOH and MOUD initiation were assessed with Cox proportional hazards models, and SDOH and substance use over time with generalized estimating equation models. RESULTS Participants (N = 114) averaged 47 years old, 63% were male, 56% were Black, and 12% Hispanic. Participants reported an average of 2.3 out of 5 positive SDOH indicators (SD = 1.2). Stable housing was the most commonly reported SDOH (61%), followed by no recent criminal justice involvement (59%), having a high-school level education or greater (56%), income stability (45%), and recent SUD care (13%). Each additional favorable SDOH was associated with a 25% increase in the likelihood of MOUD initiation during the study period [adjusted HR = 1.25, 95% CI = (1.01, 1.55), P = .044]. Positive SDOH were also associated with a decrease in the odds of baseline opioid use and a greater reduction in opioid use during subsequent weeks of the study (P < .001 for a joint test of baseline and slope differences). CONCLUSIONS Positive social determinants of health, in aggregate, may increase the likelihood of MOUD treatment initiation among people living with HIV and OUD.
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Affiliation(s)
- Ryan R. Cook
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
| | - Erin N. Jaworski
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois-Chicago, Chicago, IL
| | - Kim A. Hoffman
- Oregon Health and Science University-Portland State University School of Public Health, Portland
| | - Elizabeth N Waddell
- Oregon Health and Science University-Portland State University School of Public Health, Portland
| | - Renae Myers
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
| | - P. Todd Korthuis
- Department of Medicine, Section of Addiction Medicine, Oregon Health and Science University, Portland
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21
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Borowska M, Augustynowicz A, Olszewski P, Religioni U. Respecting the Patient's Right to Information in Hospital Wards in Poland - Socio-Economic Determinants of Patients' Opinions. Patient Prefer Adherence 2023; 17:2311-2323. [PMID: 37745630 PMCID: PMC10516204 DOI: 10.2147/ppa.s421336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/18/2023] [Indexed: 09/26/2023] Open
Abstract
Background Implementation of the patient's statutory right to information is one of determinants the quality and safety of medical services. The patients' opinions survey is an element of patient-centric care, which is now one of the most important things in modern healthcare. The main aim of the work is to examine patients' opinions on the observance of patients' right to information in the hospital and quality of healthcare in the hospital. A secondary objective was to examine the impact of socioeconomic variables on patients' opinions. Materials and Methods The study was based on the Computer-Assisted Web Interview (CAWI) questionnaire, carried out in March 2022. The sample included 801 persons. Respondents were patients hospitalized within a maximum of 12 months. The questionnaire contained closed questions about the quality of medical care, observance of the patient's right to information. Results Probability of referral was measured using the Net Promoter Score (NPS). Respondents answered the question about the recommendation on a scale from 0 to 10. People who rated the hospital ward at 10 and 9 are promoters, people who rated the hospital ward at 8 and 7 are neutral people. In turn, people who rated the hospital ward at 6, 5, 4, 3, 2, 1 or 0 are critics, ie people who will not recommend the hospital to their relatives. Most patients in hospital wards were the detractors (37%). The percentage of promoters was only 1% lower (36%) than that of the detractors. Patients was rated medical and nursing staff at a similar level with regard to the observance of the patient's right to information. Conclusion Most statistically significant differences in the assessment of medical care in the hospital ward were associated with such sociodemographic variables as age and income. People aged 55-64 and 65+ rated most of the analyzed aspects better.
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Affiliation(s)
- Mariola Borowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Warsaw, Poland
| | - Anna Augustynowicz
- Department of Economics of Health and Medical Law, Medical University of Warsaw, Warsaw, Poland
- School of Public Health Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
| | | | - Urszula Religioni
- School of Public Health Centre of Postgraduate Medical Education of Warsaw, Warsaw, Poland
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22
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Weeks WB, Chang JE, Pagán JA, Aerts A, Weinstein JN, Ferres JL. An observational, sequential analysis of the relationship between local economic distress and inequities in health outcomes, clinical care, health behaviors, and social determinants of health. Int J Equity Health 2023; 22:181. [PMID: 37670348 PMCID: PMC10478428 DOI: 10.1186/s12939-023-01984-6] [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: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Socioeconomic status has long been associated with population health and health outcomes. While ameliorating social determinants of health may improve health, identifying and targeting areas where feasible interventions are most needed would help improve health equity. We sought to identify inequities in health and social determinants of health (SDOH) associated with local economic distress at the county-level. METHODS For 3,131 counties in the 50 US states and Washington, DC (wherein approximately 325,711,203 people lived in 2019), we conducted a retrospective analysis of county-level data collected from County Health Rankings in two periods (centering around 2015 and 2019). We used ANOVA to compare thirty-three measures across five health and SDOH domains (Health Outcomes, Clinical Care, Health Behaviors, Physical Environment, and Social and Economic Factors) that were available in both periods, changes in measures between periods, and ratios of measures for the least to most prosperous counties across county-level prosperity quintiles, based on the Economic Innovation Group's 2015-2019 Distressed Community Index Scores. RESULTS With seven exceptions, in both periods, we found a worsening of values with each progression from more to less prosperous counties, with least prosperous counties having the worst values (ANOVA p < 0.001 for all measures). Between 2015 and 2019, all except six measures progressively worsened when comparing higher to lower prosperity quintiles, and gaps between the least and most prosperous counties generally widened. CONCLUSIONS In the late 2010s, the least prosperous US counties overwhelmingly had worse values in measures of Health Outcomes, Clinical Care, Health Behaviors, the Physical Environment, and Social and Economic Factors than more prosperous counties. Between 2015 and 2019, for most measures, inequities between the least and most prosperous counties widened. Our findings suggest that local economic prosperity may serve as a proxy for health and SDOH status of the community. Policymakers and leaders in public and private sectors might use long-term, targeted economic stimuli in low prosperity counties to generate local, community health benefits for vulnerable populations. Doing so could sustainably improve health; not doing so will continue to generate poor health outcomes and ever-widening economic disparities.
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Affiliation(s)
| | - Ji E Chang
- NYU School of Global Public Health, New York, NY, USA
| | - José A Pagán
- NYU School of Global Public Health, New York, NY, USA
| | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
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23
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Serchen J, Cline K, Mathew S, Hilden D. Preparing for Future Pandemics and Public Health Emergencies: An American College of Physicians Policy Position Paper. Ann Intern Med 2023; 176:1240-1244. [PMID: 37487216 DOI: 10.7326/m23-0768] [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: 07/26/2023] Open
Abstract
The onset of the COVID-19 pandemic revealed significant gaps in the United States' pandemic and public health emergency response system. At the federal level, government responses were undercut by a lack of centralized coordination, inadequately defined responsibilities, and an under-resourced national stockpile. Contradictory and unclear guidance throughout the early months of the pandemic, along with inconsistent funding to public health agencies, also created notable variance in state and local responses. The lack of a coordinated response added pressure to an already overwhelmed health care system, which was forced to resort to rationing care and personal protective equipment, creating moral distress and trauma for health care workers and their patients. Despite these severe shortcomings, the COVID-19 pandemic also highlighted successful policies and approaches, such as Operation Warp Speed, which led to the fastest development and distribution of a vaccine in history. In this position paper, the American College of Physicians (ACP) offers several policy recommendations for enhancing federal, state, and local preparedness for future pandemic and public health emergencies. This policy paper builds on various statements produced by ACP throughout the COVID-19 pandemic, including on the ethical distribution of vaccinations and resources, conditions to resume economic and social activity, and efforts to protect the health and well-being of medical professionals, among others.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S., K.C.)
| | - Katelan Cline
- American College of Physicians, Washington, DC (J.S., K.C.)
| | - Suja Mathew
- Atlantic Health System, Hinsdale, Illinois (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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24
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 236] [Impact Index Per Article: 236.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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25
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Sseguya W, James S, Bwambale M, L Klatman E, D Ogle G, Munyagwa M, Maniam J, Wesonga R, Bahendeka S. Type 1 diabetes patient experiences and management practices during the COVID-19 pandemic in rural Uganda. J Diabetes Metab Disord 2023; 22:1-9. [PMID: 37363199 PMCID: PMC10201465 DOI: 10.1007/s40200-023-01222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/31/2023] [Indexed: 06/28/2023]
Abstract
Background The COVID-19 pandemic has impacted various aspects of the lives of persons with chronic diseases, including type 1 diabetes (T1D). However, the diabetes care experiences and practices adopted by persons living with T1D after the declaration of the COVID-19 pandemic in Uganda have not been well documented. Objectives We investigated diabetes management practices and experiences of persons with T1D during the COVID-19 pandemic lockdown in a rural district of southwestern Uganda. Methods Using interactive sequential explanatory mixed methods, we conducted a cross-sectional study of persons with T1D aged 18-25 years, their caregivers and health workers. Quantitative data was exclusively collected from patients with T1D using Kobo Toolbox™ and analysed with SPSS™ version 26; qualitative interviews were used to elicit responses from purposively selected patients with T1D, plus caregivers and health workers that were analysed using a thematic framework approach. Results The study enrolled 51 (24 males) patients with T1D; diabetes duration (mean ± SD) 6.6 ± 5 years. Access to insulin syringes significantly worsened in 19.6% of participants (p = 0.03). Insulin injection frequency (p = 0.01), blood glucose monitoring (p = 0.001) and meal frequency (p = 0.0001) significantly decreased. Qualitative interviews highlighted COVID-19 restriction measures had reduced household income, frequency of clinic visits, and access to food, diabetes support and social services. Conclusions Experiences and practices were consistent with decisions to prioritise survival, even with known risks around metabolic control. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01222-4.
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Affiliation(s)
| | - Steven James
- University of the Sunshine Coast, Petrie, QLD Australia
- Life for a Child Program, Diabetes NSW & ACT, Sydney, NSW Australia
| | | | - Emma L Klatman
- Life for a Child Program, Diabetes NSW & ACT, Sydney, NSW Australia
| | - Graham D Ogle
- Life for a Child Program, Diabetes NSW & ACT, Sydney, NSW Australia
| | | | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW & ACT, Sydney, NSW Australia
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Kiser JW. The decision to reimage following extravasation in diagnostic nuclear medicine. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2023; 3:1171918. [PMID: 39355035 PMCID: PMC11440986 DOI: 10.3389/fnume.2023.1171918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/03/2023] [Indexed: 10/03/2024]
Abstract
The primary goal of diagnostic nuclear medicine is to provide complete and accurate reports without equivocation or disclaimers. If specific clinical questions cannot be answered because of radiopharmaceutical extravasation, the imaging study may have to be repeated. The decision to reimage is based on several factors including the diagnostic quality of the images, additional patient radiation dose, patient burden, and administrative constraints. Through process improvement efforts, nuclear medicine departments can significantly reduce the frequency of extravasation and thereby also the need for reimaging. Communication with the patient is important any time extravasation may impact their immediate or future care. The circumstances and potential ramifications should be explained, and patient concerns should be addressed. Although recent arguments have been made in favor of investigating and addressing only those extravasations which result in serious patient injury, patients and their referring physicians deserve to know any time their nuclear medicine study may have been impacted.
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Affiliation(s)
- Jackson W Kiser
- Department of Molecular Imaging, Carilion Clinic, Roanoke, VA, United States
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Timmer-Murillo SC, Schroeder ME, Trevino C, Geier TJ, Schramm AT, Brandolino AM, Hargarten S, Holena D, de Moya M, Milia D, deRoon-Cassini TA. Comprehensive Framework of Firearm Violence Survivor Care: A Review. JAMA Surg 2023; 158:541-547. [PMID: 36947025 DOI: 10.1001/jamasurg.2022.8149] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Importance Firearm violence is a public health crisis placing significant burden on individuals, communities, and health care systems. After firearm injury, there is increased risk of poor health, disability, and psychopathology. The newest 2022 guidelines from the American College of Surgeons Committee on Trauma require that all trauma centers screen for risk of psychopathology and provide referral to intervention. Yet, implementing these guidelines in ways that are responsive to the unique needs of communities and specific patient populations, such as after firearm violence, is challenging. Observations The current review highlights important considerations and presents a model for trauma centers to provide comprehensive care to survivors of firearm injury. This model highlights the need to enhance standard practice to provide patient-centered, trauma-informed care, as well as integrate inpatient and outpatient psychological services to address psychosocial needs. Further, incorporation of violence prevention programming better addresses firearm injury as a public health concern. Conclusions and Relevance Using research to guide a framework for trauma centers in comprehensive care after firearm violence, we can prevent complications to physical and psychological recovery for this population. Health systems must acknowledge the socioecological context of firearm violence and provide more comprehensive care in the hospital and after discharge, to improve long-term recovery and serve as a means of tertiary prevention of firearm violence.
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Affiliation(s)
| | - Mary E Schroeder
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Colleen Trevino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Timothy J Geier
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Andrew T Schramm
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Amber M Brandolino
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Stephen Hargarten
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee
| | - Daniel Holena
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
| | - David Milia
- Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee
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Killough CM, Madaras A, Phillips C, Hettema J, Ceballos V, Fuentes JE, Rishel Brakey H, Wagner K, Page K. Community health worker insights on promoting research engagement with diverse populations. Front Public Health 2023; 10:959504. [PMID: 36711331 PMCID: PMC9874150 DOI: 10.3389/fpubh.2022.959504] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Representation of diverse populations in health research enhances our ability to understand the factors that impact health, generalize results, implement findings, and promote social justice. The primary objective of the study was to understand the unique perspectives of frontline community health workers (CHWs) to identify actionable barriers and facilitators that may impact representation of diverse groups in health research. Focus groups with CHWs were conducted followed by thematic analysis. Results revealed five main themes: barriers/risks to research participation, facilitation of research, CHW roles, recommendations, and transparency. A novel finding was that some CHWs see themselves as both facilitators and gatekeepers. As facilitators, CHWs ensure their patient populations receive resources and benefit from being involved in research; as gatekeepers CHWs feel that they protect patient populations from experiencing further trauma, especially when engaging in research. Recognizing that in many communities there is a high reliance and trust with CHWs, can promote genuine and informed participation at all stages of research.
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Affiliation(s)
- Cynthia M. Killough
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States,*Correspondence: Cynthia M. Killough ✉
| | - Annemarie Madaras
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Christina Phillips
- Department of Family and Community Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | | | - Venice Ceballos
- Community Health Worker Initiatives, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Jesus E. Fuentes
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Heidi Rishel Brakey
- Clinical and Translational Science Center, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Katherine Wagner
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Kimberly Page
- Department of General Internal Medicine, UNM Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
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Abstract
Purpose of Review Population aging is occurring worldwide, particularly in developed countries such as the United States (US). However, in the US, the population is aging more rapidly in rural areas than in urban areas. Healthy aging in rural areas presents unique challenges. Understanding and addressing those challenges is essential to ensure healthy aging and promote health equity across the lifespan and all geographies. This review aims to present findings and evaluate recent literature (2019-2022) on rural aging and highlight future directions and opportunities to improve population health in rural communities. Recent Findings The review first addresses several methodological considerations in measuring rurality, including the choice of measure used, the composition of each measure, and the limitations and drawbacks of each measure. Next, the review considers important concepts and context when describing what it means to be rural, including social, cultural, economic, and environmental conditions. The review assesses several key epidemiologic studies addressing rural-urban differences in population health among older adults. Health and social services in rural areas are then discussed in the context of healthy aging in rural areas. Racial and ethnic minorities, indigenous peoples, and informal caregivers are considered as special populations in the discussion of rural older adults and healthy aging. Lastly, the review provides evidence to support critical longitudinal, place-based research to promote healthy aging across the rural-urban divide is highlighted. Summary Policies, programs, and interventions to reduce rural-urban differences in population health and to promote health equity and healthy aging necessitate a context-specific approach. Considering the cultural context and root causes of rural-urban differences in population health and healthy aging is essential to support the real-world effectiveness of such programs, policies, and interventions.
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Affiliation(s)
- Steven A. Cohen
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI USA
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Borowska M, Religioni U, Augustynowicz A. Patients' Opinions on the Quality of Services in Hospital Wards in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:412. [PMID: 36612739 PMCID: PMC9819877 DOI: 10.3390/ijerph20010412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Patient opinion surveys have become a widely used method for assessing key aspects of the functioning of medical facilities and, thus, of the functioning of the entire health care system. They are a prerequisite for developing patient-centered care and an essential component of quality improvement programs. In many countries, including Poland, patient opinion surveys are written into the accreditation standards of medical institutions. Patient's readiness to recommend a hospital is a recognized indicator of the quality of patient-centered care. In a report on strategies for improving the quality of health care in Europe published in 2019 by WHO and the OECD (Organisation for Economic Cooperation and Development), patient's readiness to recommend a hospital was cited as one of the basic indicators of 'patient centeredness' along with patient satisfaction. Therefore, as well consideration of the quality of medical care, a patient recommendation index was also used in the study presented in this paper. The index was based on the answers to questions about the patient's readiness to recommend a hospital ward to family and friends. AIM The aim of the study was to investigate patients' opinions on the quality of services in particular hospital wards. A patient opinion survey can be used to improve the quality of services and monitor the effects of health-related activities, identify areas that need improvement, motivate medical staff and prevent their burnout, build a trusting relationship with patients, and compare the quality of health care in various facilities. MATERIAL AND METHODS The study was carried out in March 2022. The patient opinion survey was conducted using the CAWI (Computer-Assisted Web Interview). The sample selection was purposive. The respondents were patients with a history of hospitalization. The sample selection used an algorithm for the random selection of patients who met the criteria for the sample. The inclusion criterion was hospitalization in the 12 months prior to the study. A standardized questionnaire was used that was aimed at the assessment of the quality of medical care and the patient's rights to information. Additionally, the survey contained questions about the demographic characteristics of the respondents. RESULTS A total of 38% of patients with a history of hospitalization expressed criticisms. The majority of statistically significant differences were observed when differentiating respondents according to age. Elderly persons significantly more often declared having been treated with respect and interest. They also rated more highly the meals served in the hospital, effective pain treatment, and respect for the patient's dignity and intimacy during diagnosis and treatment. Younger persons assessed all these aspects of hospitalization less favorably. CONCLUSIONS Variables including age and the level of income had a statistically significant influence on the opinion of the respondents. Elderly persons assessed most aspects of the quality of care in a hospital ward more favorably. There were a similar number of "promoters" (36%) and "detractors" (38%) of the quality of hospital services. Detractors mainly pointed to long waiting times for hospital admission, the poor quality of medical and nursing care, and unappealing meals. The promoters emphasized the high quality of medical and nursing care and the favorable conditions of the accommodation. Regular patient satisfaction surveys are helpful in identifying areas in which the functioning of a medical entity requires changes.
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Affiliation(s)
- Mariola Borowska
- Department of Economics of Health and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Urszula Religioni
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
| | - Anna Augustynowicz
- Department of Economics of Health and Medical Law, Medical University of Warsaw, 02-091 Warsaw, Poland
- School of Public Health, Centre of Postgraduate Medical Education of Warsaw, 01-813 Warsaw, Poland
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Kendig NE, Butkus R, Mathew S, Hilden D. Health Care During Incarceration: A Policy Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1742-1745. [PMID: 36410006 DOI: 10.7326/m22-2370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.
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Affiliation(s)
- Newton E Kendig
- School of Medicine and Health Sciences, George Washington University, Washington, DC (N.E.K.)
| | - Renee Butkus
- American College of Physicians, Washington, DC (R.B.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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Tedford NJ, Keating EM, Ou Z, Holsti M, Wallace AS, Robison JA. Social Needs Screening During Pediatric Emergency Department Visits: Disparities in Unmet Social Needs. Acad Pediatr 2022; 22:1318-1327. [PMID: 35537675 PMCID: PMC9910325 DOI: 10.1016/j.acap.2022.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/15/2022] [Accepted: 05/01/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine the prevalence of unmet social needs (USN) in a pediatric emergency department (PED) patient population and examine disparities in USN by self-selected language and patient demographics. METHODS We surveyed a convenience sample of English- and Spanish-speaking caregivers of patients <18-years-old presenting to a free-standing children's hospital in Salt Lake City, Utah. In the caregiver's self-selected language, the pediatric version of the Screener for Intensifying Community Referrals for Health (p-SINCERE) assessed patient demographics and 10 areas of social needs. The primary outcome was presence of USN. Descriptive statistics compared 1) self-selected languages and 2) absence versus presence of USN. Patient and caregiver-level risk factors associated with USN were identified using multivariable logistic regression. RESULTS Of the 10,156 patients seen in our PED from 04/01/2021 to 08/03/2021, there were 9922 eligible, 5357 approached, and 3987 enrolled caregivers. Of the 3987 caregivers enrolled, self-selected language was English for 3662 (91.8%) and Spanish for 325 (8.2%). There were 1680 enrolled caregivers with ≥1 USN, representing 39.7% of English-speaking and 70.2% of Spanish-speaking caregivers (P < .001). The odds of having ≥1 USN was more than 2 times higher in Spanish-speakers than in English-speakers after adjustment. CONCLUSIONS USN are common for families presenting for care to a PED, especially among Spanish-speaking caregivers. Furthermore, this study demonstrates disparities in limited English proficiency, race and ethnicity, and child insurance status. These findings support the practicality of utilizing the PED as an access point to initiate social need screening and referrals to address social determinants of health and health disparities.
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Affiliation(s)
- Natalie J Tedford
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah.
| | - Elizabeth M Keating
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah (Z Ou), Salt Lake City, Utah
| | - Maija Holsti
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
| | - Andrea S Wallace
- University of Utah, College of Nursing (AS Wallace), Salt Lake City, Utah; Department of Population Sciences, University of Utah (AS Wallace), Salt Lake City, Utah
| | - Jeff A Robison
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah (EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah; Intermountain Primary Children's Hospital (NJ Tedford, EM Keating, M Holsti, and JA Robison), Salt Lake City, Utah
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Chua IS, Shi SM, Jia Z, Leiter R, Rodriguez JA, Sivashanker K, Yeh IM, Bernacki R, Levine DM. Differences in End-of-Life Care between COVID-19 Inpatient Decedents with English Proficiency and Limited English Proficiency. J Palliat Med 2022; 25:1629-1638. [PMID: 35575745 PMCID: PMC9836680 DOI: 10.1089/jpm.2021.0541] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Patients with limited English proficiency (LEP) experience lower quality end-of-life (EOL) care. This inequity may have been exacerbated during the COVID-19 pandemic. Objective: Compare health care utilization, EOL, and palliative care outcomes between COVID-19 decedents with and without LEP during the pandemic's first wave in Massachusetts. Methods: Retrospective cohort study of adult inpatients who died from COVID-19 between February 18, 2020 and May 18, 2020 at two academic and four community hospitals within a greater Boston health care system. We performed multivariable regression adjusting for patient sociodemographic variables and hospital characteristics. Primary outcome was place of death (intensive care unit [ICU] vs. non-ICU). Secondary outcomes included hospital and ICU length of stay and time to initial palliative care consultation. Results: Among 337 patients, 89 (26.4%) had LEP and 248 (73.6%) were English proficient. Patients with LEP were less often white (24 [27.0%] vs. 193 [77.8%]; p < 0.001); were more often Hispanic or Latinx (40 [45.0%] vs. 13 [5.2%]; p < 0.001); and less often had a medical order for life-sustaining treatment (MOLST) on admission (15 [16.9%] vs. 120 [48.4%]; p < 0.001) versus patients with English proficiency. In the multivariable analyses, LEP was not independently associated with ICU death, ICU length of stay, or time to palliative care consultation, but was independently associated with increased hospital length of stay (mean difference 4.12 days; 95% CI, 1.72-6.53; p < 0.001). Conclusions: Inpatient COVID-19 decedents with LEP were not at increased risk of an ICU death, but were associated with an increased hospital length of stay versus inpatient COVID-19 decedents with English proficiency.
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Affiliation(s)
- Isaac S. Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sandra M. Shi
- Harvard Medical School, Boston, Massachusetts, USA
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Zhimeng Jia
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Richard Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge A. Rodriguez
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Irene M. Yeh
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Rachelle Bernacki
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - David M. Levine
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Serchen J, Mathew S, Hilden D, Southworth M, Atiq O. Supporting the Health and Well-Being of Indigenous Communities: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1594-1597. [PMID: 36215716 DOI: 10.7326/m22-1891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Indigenous peoples in the United States experience many health disparities and barriers to accessing health care services. In addition, Indigenous communities experience poor social drivers of health, including disproportionately high rates of food insecurity, violence, and poverty, among others. These challenges are unsurprising, given historical societal discrimination toward Indigenous peoples and government policies of violence, forced relocation with loss of ancestral home, and erasure of cultures and traditions. Indigenous peoples have displayed resilience that has sustained their communities through these hardships. Through treaties between the federal government and Indigenous nations, the federal government has assumed a trust responsibility to provide for the health and well-being of Indigenous populations through the direct provision of health care services and financial support of tribally operated health systems. However, despite serving a population that has endured substantial historical trauma and subsequent health issues, federal programs serving Indigenous peoples receive inadequate federal funding and substantially fewer resources compared with other federal health care programs. Access to care is further challenged by geographic isolation and health care workforce vacancies. Given the history of Indigenous peoples in the United States and their treatment by the federal government and society, the American College of Physicians (ACP) asserts the federal government must faithfully execute its trust responsibility through increased funding and resources directed toward Indigenous communities and the undertaking of concerted policy efforts to support the health and well-being of Indigenous people. ACP believes that these efforts must be community-driven, Indigenous-led, and culturally appropriate and accepted, and center values of respect and self-determination.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | - Suja Mathew
- Atlantic Health System, Morristown, New Jersey (S.M.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | - Molly Southworth
- WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, Alaska (M.S.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
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Phelps A, Lawrence-Wood E, Couineau AL, Hinton M, Dolan P, Smith P, Notarianni M, Forbes D, Hosseiny F. Mental Health Reform: Design and Implementation of a System to Optimize Outcomes for Veterans and Their Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12681. [PMID: 36231981 PMCID: PMC9565186 DOI: 10.3390/ijerph191912681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
The social, health, and economic burden of mental health problems in the veteran community is heavy. Internationally, the array of services and support available to veterans and their families are extensive but vary in quality, are often disconnected, complex to navigate, and lack clear coordination. This paper describes a conceptual framework to guide the design and implementation of a system of services and supports to optimize the mental health and wellbeing of all veterans and their families. The framework recognizes the diversity of veterans across intersecting identities that uniquely shape experiences of posttraumatic mental health and wellbeing. It brings together several strands of research: the values and principles that should underpin the system; the needs of diverse veterans and their families; challenges in the current services and supports; evidence-based interventions; and principles of effective implementation. Central to the future system design is a next generation stepped model of care that organizes best and next practice interventions in a coherent system, matches service provision to level of need and addresses access and navigation. Practical guidance on implementation provides an aspirational and flexible structure for system evolution, and a template for all stakeholders-individuals, groups, agencies and organizations-to effect system change.
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Affiliation(s)
- Andrea Phelps
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Ellie Lawrence-Wood
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Anne-Laure Couineau
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Mark Hinton
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Paul Dolan
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Patrick Smith
- Atlas Institute for Veterans and Families, Ottawa, ON K1Z 7K4, Canada
| | | | - David Forbes
- Phoenix Australia—Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Fardous Hosseiny
- Atlas Institute for Veterans and Families, Ottawa, ON K1Z 7K4, Canada
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Castillo AF, Davis AL, Krishnamurti T. Using implementation science frameworks to translate and adapt a pregnancy app for an emerging Latino community. BMC Womens Health 2022; 22:386. [PMID: 36131336 PMCID: PMC9490971 DOI: 10.1186/s12905-022-01975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Digital mobile health (mHealth) applications are a popular form of prenatal education and care delivery in the U.S.; yet there are few Spanish language options for native speakers. Furthermore, existing applications do not consider cultural differences and disparities in healthcare access, including those specific to emerging Latino communities. Objective To adapt and translate an English-language pregnancy mobile health app to meet the language and cultural needs of Spanish-speaking Latino immigrants living in the United States. Methods We use a multi-step process, grounded in implementation science frameworks, to adapt and translate the contents of an existing pregnancy app. Interviews with stakeholders (n = 12) who advocate for the needs of pregnant individuals in an emerging Latino community were used to identify domains of possible disparities in access to prenatal care. We then conducted semi-structured interviews with peripartum Spanish-speaking Latino users (n = 14) to understand their perspectives within those domains. We identified a list of topics to create educational material for the modified app and implemented a systematic translation approach to ensure that the new version was acceptable for immigrants from different countries in Latin America. Results The interviews with stakeholders revealed seven critical domains that need to be addressed in an adapted prenatal app: language and communication, financial concerns, social support, immigration status, cultural differences, healthcare navigation, and connection to population-specific community resources that offer Spanish language services. The interviews with peripartum Spanish-speaking Latino women informed how the existing content in the app could be adjusted or built upon to address these issues, including providing information on accessing care offered in their native language and community support. Finally, we used a systematic approach to translate the existing application and create new content. Conclusion This work illustrates a process to adapt an mHealth pregnancy app to the needs of an emerging Latino community, by incorporating culturally sensitive Spanish language content while focusing on addressing existing health disparities.
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Pysmenna O, Anderson KM. Income and Health Perceptions in an Economically Disadvantaged Community: A Qualitative Case Study from Central Florida. INTERNATIONAL JOURNAL OF COMMUNITY WELL-BEING 2022; 5:687-710. [PMID: 35996742 PMCID: PMC9387410 DOI: 10.1007/s42413-022-00177-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 07/20/2022] [Indexed: 11/03/2022]
Abstract
The link between income and adverse health outcomes continues to be problematic among racially and economically segregated urban communities. Although the consequences of living in areas of concentrated disadvantage have been delineated, there is a dearth of knowledge on how citizens from such areas perceive the effects of neighborhood characteristics on their individual and community health. This qualitative study explored how minority residents ( N = 23) viewed the intersectionality of income and health within their urban neighborhoods of economic distress. Focus groups were conducted using semi-structured interviews to better understand health concerns, needs, and barriers for individuals and their community. The main finding highlighted how residents desired to be healthy, but economic barriers prevented them from maintaining a healthy lifestyle and diet. While residing in a concentrated disadvantaged community, lack of income and power contributed to stress and fear that forced residents to prioritize survival over their wellbeing. Implications for improving individual and community health include operating within a systems framework to affect collective efficacy and empowerment among residents of low-income neighborhoods.
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Serchen J, Atiq O, Hilden D. Strengthening Food and Nutrition Security to Promote Public Health in the United States: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1170-1171. [PMID: 35759767 DOI: 10.7326/m22-0390] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Food insecurity functions as a social driver of health, directly negatively impacting health status and outcomes, which can further negatively impact employment and income and increase medical expenditures-all of which exacerbates food insecurity. Progress in meaningfully reducing the food-insecurity rate has stalled in recent years. Although rates have decreased since their peak during the Great Recession, these gains have been reversed by the economic implications of the COVID-19 pandemic. As the federal government is the largest provider of food assistance, there is much potential in better leveraging nutrition assistance programs like the Supplemental Nutrition Assistance Program (SNAP) and the Child Nutrition Programs to increase access to healthful foods and improve public health. However, these programs face many funding challenges and internal shortcomings that create uncertainties and prevent maximal effect. Physicians and other medical professionals also have a role in improving nutritional health by screening for food insecurity and serving as connectors between patients, community organizations, and government services. Governments and payers must support these efforts by providing sufficient resources to practices to fulfill this role. In this position paper, the American College of Physicians (ACP) offers several policy recommendations to strengthen the federal food-insecurity response and empower physicians and other medical professionals to better address those social drivers of health occurring beyond the office doors.
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Affiliation(s)
- Josh Serchen
- American College of Physicians, Washington, DC (J.S.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
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Davidson MM, Alonzo CN, Stransky ML. Access to Speech and Language Services and Service Providers for Children With Speech and Language Disorders. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1702-1718. [PMID: 35613324 DOI: 10.1044/2022_ajslp-21-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The purposes of this study were to (a) examine children's access to services for their speech and language disorders during their lifetimes; (b) identify any child, disorder, and family characteristics associated with access to services; and (c) describe the speech and language service providers among children who received care. STUDY DESIGN Data from the 2012 National Health Interview Survey were used for this retrospective cohort study. Our sample included 491 children (ages 3;0-17;11 [years;months]) with speech disorders and 333 children with language disorders. We measured the receipt of services for speech or language difficulties (main outcome) and the type of professional providing services (secondary outcome). We examined associations between services and child, disorder, and family characteristics. RESULTS Approximately 75% of children with speech and language disorders had ever received services for their difficulties. Privately insured children and children with co-occurring conditions were more likely to receive services than their peers who were uninsured (speech: 6.1 [1.7,21.3]; language: 6.6 [1.3,32.9]) and had no co-occurring conditions (speech: 2.1 [1.2,3.9]; language: 2.9 [1.5,5.5]). Speech-language pathologists (SLPs) were the most commonly reported provider of services (speech: 68%, language: 60%) followed by early interventionists. CONCLUSIONS Most children with speech and language disorders received services. However, disparities existed by race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration (speech only). Most children who received services were being provided with care by the experts of speech and language: SLPs. Updated population-based data and implementation studies are needed to document speech and language screening, referral, and access to services. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19799389.
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Pope CN, Stavrinos D, Fazeli PL, Vance DE. Transportation Barriers and Health-Related Quality of Life in a Sample of Middle-Aged and Older Adults Living with HIV in the Deep South. AIDS Behav 2022; 26:2148-2158. [PMID: 35066731 PMCID: PMC8783768 DOI: 10.1007/s10461-021-03560-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 12/01/2022]
Abstract
Access to reliable transportation is a social determinant of health imperative for disease management for those aging with HIV/AIDS. To what degree transportation barriers are associated with health-related quality of life (HRQOL) in middle-aged and older people living with HIV (PWH) in the Deep South region of the United States is presently unknown. PWH (n = 261, age range = 39 to 73 years old, 80.1% African American, 64.4% male) were recruited from an academic medical center in the Deep South. Variables included sociodemographics, HIV characteristics, depressive symptoms, HRQOL, and perceived transportation barriers. Spearman rho correlations and linear regressions accounting for covariates were conducted. After accounting for covariates, greater perceived transportation barriers were associated with worse health perceptions, pain, social functioning, health distress, and health transitions. Access to reliable transportation is a key factor in improving health for PWH. Considerations for healthcare and traffic safety are discussed.
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Affiliation(s)
- Caitlin N Pope
- Department of Health, Behavior & Society, University of Kentucky, Lexington, KY, USA.
- Graduate Center for Gerontology, 725 Rose St. Suite 401 Multidisciplinary Sciences Building, Lexington, KY, 40536, USA.
| | - Despina Stavrinos
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pariya L Fazeli
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David E Vance
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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Campbell T, Rodgers YVDM. Health insurance coverage and health outcomes among transgender adults in the United States. HEALTH ECONOMICS 2022; 31:973-992. [PMID: 35246917 DOI: 10.1002/hec.4483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
This study provides evidence of health and insurance coverage disparities between the cisgender and transgender US populations using repeated cross sections from the 2014-2020 Behavioral Risk Factors Surveillance Systems. The analysis tests whether increasing the incidence of insurance coverage among transgender people could alleviate the health disparity. The empirical approach uses a fuzzy regression discontinuity design that leverages breaks in government health assistance eligibility by age. Results indicate that, for transgender recipients only, insurance coverage meaningfully improves mental health; for cisgender recipients only, insurance coverage reduces difficulties with concentration and memory; and for both the transgender and cisgender populations, insurance coverage contributes to important improvements in physical health, overall health, and healthcare access.
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Affiliation(s)
- Travis Campbell
- Department of Economics, Southern Oregon University, Ashland, Oregon
| | - Yana van der Meulen Rodgers
- Labor Studies and Employment Relations Department, School of Management and Labor Relations, Rutgers University, Piscataway, New Jersey, USA
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Kitzman H, Tecson K, Mamun A, da Graca B, Yeramaneni S, Halloran K, Wesson D. Integrating Population Health Strategies into Primary Care: Impact on Outcomes and Hospital Use for Low-Income Adults. Ethn Dis 2022; 32:91-100. [PMID: 35497399 DOI: 10.18865/ed.32.2.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Our objectives were two-fold: 1) To evaluate the benefits of population health strategies focused on social determinants of health and integrated into the primary care medical home (PCMH) and 2) to determine how these strategies impact diabetes and cardiovascular disease outcomes among a low-income, primarily minority community. We also investigated associations between these outcomes and emergency department (ED) and inpatient (IP) use and costs. Design Retrospective cohort. Setting Community-based PCMH: Baylor Scott & White Health and Wellness Center (BSW HWC). Patients/Participants All patients who attended at least two primary care visits at BSW HWC within a 12-month time span from 2011-2015. Methods Outcomes for patients participating in PCMH only (PCMH) as compared to PCMH plus population health services (PCMH+PoPH) were compared using electronic health record data. Main Outcomes Diastolic and systolic blood pressure, hemoglobin A1c, ED visits and costs, and IP hospitalizations and costs were examined. Results From 2011-2015, 445 patients (age=46±12 years, 63% African American, 61% female, 69.5% uninsured) were included. Adjusted regression analyses indicated PCMH+PoPH had greater improvement in diabetes outcomes (prediabetes HbA1c= -.65[SE=.32], P=.04; diabetes HbA1c= -.74 [SE=.37], P<.05) and 37% lower ED costs than the PCMH group (P=.01). Worsening chronic disease risk factors was associated with 39% higher expected ED visits (P<.01), whereas improved chronic disease risk was associated with 32% fewer ED visits (P=.04). Conclusions Integrating population health services into the PCMH can improve chronic disease outcomes, and impact hospital utilization and cost in un- or under-insured populations.
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Affiliation(s)
- Heather Kitzman
- Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, TX; Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX
| | - Kristen Tecson
- Baylor Scott & White Heart and Vascular Institute, Baylor Scott & White Health, Dallas, TX
| | - Abdullah Mamun
- Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, TX; Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX
| | | | | | - Kenneth Halloran
- Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, TX; Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX
| | - Donald Wesson
- Baylor Scott & White Health and Wellness Center, Baylor Scott & White Health, Dallas, TX; Robbins Institute for Health Policy & Leadership, Baylor University, Waco, TX
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Heisler M, Lapidos A, Kieffer E, Henderson J, Guzman R, Cunmulaj J, Wolfe J, Meyer T, Ayanian JZ. Impact on Health Care Utilization and Costs of a Medicaid Community Health Worker Program in Detroit, 2018-2020: A Randomized Program Evaluation. Am J Public Health 2022; 112:766-775. [PMID: 35324259 PMCID: PMC9010898 DOI: 10.2105/ajph.2021.306700] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To compare health care utilization and costs between beneficiaries randomly assigned to usual services versus a community health worker (CHW) program implemented by 3 Medicaid health plans. Methods. From February 2018 to June 2019, beneficiaries residing in Detroit, Michigan's Cody Rouge neighborhood with more than 3 emergency department (ED) visits or at least 1 ambulatory care‒sensitive hospitalization in the previous 12 months were randomized. CHWs reached out to eligible beneficiaries to assess their needs and link them to services. We compared ED and ambulatory care visits, hospitalizations, and related costs over 12 months. Results. In intention-to-treat analyses among 2457 beneficiaries, the 1389 randomized to the CHW program had lower adjusted ratios of ED visits (adjusted rate ratio [ARR] = 0.96; P < .01) and ED visit costs (ARR = 0.96; P < .01), but higher adjusted ratios of ambulatory care costs (ARR = 1.15; P < .01) and no differences in inpatient or total costs compared with the usual-care group. Conclusions. Initial increases in ambulatory care use from effective programs for underserved communities may mitigate savings from decreased acute care use. Longer-term outcomes should be followed to assess potential cost savings from improved health. Trial Registration: ClinicalTrials.gov identifier: NCT03924713. (Am J Public Health. 2022;112(5):766-775. https://doi.org/10.2105/AJPH.2021.306700).
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Affiliation(s)
- Michele Heisler
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Adrienne Lapidos
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Edith Kieffer
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - James Henderson
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Rebeca Guzman
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Jasmina Cunmulaj
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Jason Wolfe
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - Trish Meyer
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
| | - John Z Ayanian
- Michele Heisler is with the University of Michigan Medical School, Ann Arbor. Adrienne Lapidos is with the University of Michigan Department of Psychiatry, Ann Arbor. Edith Kieffer is with the University of Michigan School of Social Work, Ann Arbor. James Henderson is with the University of Michigan Consulting for Statistics, Computing and Analytics Research, Ann Arbor. Rebeca Guzman is with the Detroit Health Department, Detroit, MI. Jasmina Cunmulaj is with the University of Michigan School of Public Health, Ann Arbor. Jason Wolfe, Trish Meyer, and John Z. Ayanian are with the University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor
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Smith ML, Bergeron CD, Sherman LD, Goidel K, Merianos AL. Contextualizing the Chronic Care Model among Non-Hispanic Black and Hispanic Men with Chronic Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3655. [PMID: 35329342 PMCID: PMC8951030 DOI: 10.3390/ijerph19063655] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/18/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023]
Abstract
Middle-aged and older men of color with chronic conditions have low utilization of preventive health services. In the context of the Chronic Care Model (CCM), the objective of this study was to identify perceptions about being informed, activated patients and having productive interactions in healthcare settings among non-Hispanic Black and Hispanic middle-aged and older men with chronic health conditions in the United States. Using an internet-based survey deployed nationally using a Qualtrics panel, data were collected from a sample of non-Hispanic Black and Hispanic men aged 40 years and older with one or more self-reported chronic conditions (n = 2028). Chi-square tests and one-way ANOVAs were used to describe this national sample by race/ethnicity and age group (40-64 years and ≥65 years). Results suggest that most health-related factors differed more on age than by race/ethnicity. Younger age groups reported less preventive care, greater barriers to self-care, mental health issues, and risky behavior. Findings from this study provide insight into the health status and healthcare utilization of racial/ethnic men with one or more chronic conditions. Results may help inform prevention and treatment interventions for middle-aged and older men of color.
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Affiliation(s)
- Matthew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; (C.D.B.); (A.L.M.)
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Caroline D. Bergeron
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; (C.D.B.); (A.L.M.)
- LIFE Research Institute, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Ledric D. Sherman
- Department of Health and Kinesiology, College of Education, Texas A&M University, College Station, TX 77845, USA;
| | - Kirby Goidel
- Public Policy Research Institute, Texas A&M University, College Station, TX 77843, USA;
- Department of Communication, College of Liberal Arts, Texas A&M University, College Station, TX 77843, USA
| | - Ashley L. Merianos
- Center for Population Health and Aging, Texas A&M University, College Station, TX 77843, USA; (C.D.B.); (A.L.M.)
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA
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Chang DS, Chen WL, Wang R. Impact of the bidirectional relationship between communication and cognitive efficacy on orthopedic patient adherence behavior. BMC Health Serv Res 2022; 22:199. [PMID: 35164761 PMCID: PMC8845262 DOI: 10.1186/s12913-022-07575-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 02/01/2022] [Indexed: 02/03/2023] Open
Abstract
Background There is growing interest in patient autonomy, and communication between physicians and patients has become the essential cornerstone for improving the quality of healthcare services. Previous research has concentrated on the direct effect of physician-patient communication on service outcomes. In the present study, we examined the influence among constructs in the service process and the impact on healthcare outcomes. The present study used behavioral theory to expand the process aspect of the Donabedian healthcare service quality structure-process-outcome model to examine the impact of cognitive changes and communication feedback on patients’ adherence behavior. In addition, the moderating effect of hospital facility levels is examined. Methods A conceptual model was developed and tested using a questionnaire administered to patients in eight hospitals. A total of 397 respondents returned usable surveys, with a response rate of 92.11%. Structural equation modeling was used to analyze the data in two steps that involved a measurement model and a structural model. The former was applied to estimate the Cronbach’s alphas, intercorrelations of factors, and descriptive statistics; the latter was used to test the hypothesized relationships of the constructs. Results The results identified three mediators of the healthcare process within the healthcare services framework: physician-patient communication, cognitive efficacy, and adherence behavior. Physician-patient communication influenced cognitive efficacy (β = 0.16, p < 0.001), and cognitive efficacy influenced physician-patient communication (β = 0.18, p < 0.001). The effect of this bidirectional relationship on adherence behavior was positive (β = 0.38, p < 0.001). The healthcare structure influenced healthcare outcomes via these three healthcare process constructs. The adherence behavior of patients who were treated in the medical center has greater influences by the structure and physician-patient communication than it was treated in the regional hospitals. Conclusions This study revealed a complex pattern in relationships among process constructs for healthcare services. The findings of this study acknowledge the important potential interrelationships among the healthcare service constructs to improve the quality of healthcare outcomes. Trial registration CRREC104107. Date: 22/01/2016. Prospectively Registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07575-5.
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Affiliation(s)
- Dong-Shang Chang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
| | - Wil-Lie Chen
- School of Nursing, China Medical University, Taichung, Taiwan.
| | - Rouwen Wang
- Department of Business Administration, National Central University, Taoyuan, Taiwan
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Rushing MD, Montoya-Barthelemy AG, Abrar FA, Medina EM, Popoola-Samuel HAO, McKinney ZJ. Law Enforcement Violence in the Black Community: A Catalyst for Clinician Engagement in Social Justice. Am J Prev Med 2022; 62:122-127. [PMID: 34674924 DOI: 10.1016/j.amepre.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Marcus D Rushing
- HealthPartners Occupational and Environmental Medicine Residency, HealthPartners St. Paul Clinic, St. Paul, Minnesota; Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Andre G Montoya-Barthelemy
- HealthPartners Occupational and Environmental Medicine Residency, HealthPartners St. Paul Clinic, St. Paul, Minnesota
| | - Fozia A Abrar
- HealthPartners Occupational and Environmental Medicine Residency, HealthPartners St. Paul Clinic, St. Paul, Minnesota
| | - Eduardo M Medina
- HealthPartners Park Nicollet Clinic Minneapolis, Minneapolis, Minnesota
| | - Helen A O Popoola-Samuel
- HealthPartners Occupational and Environmental Medicine Residency, HealthPartners St. Paul Clinic, St. Paul, Minnesota; College of Health Sciences, Rush University, Chicago, Illinois
| | - Zeke J McKinney
- HealthPartners Occupational and Environmental Medicine Residency, HealthPartners St. Paul Clinic, St. Paul, Minnesota; Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota; HealthPartners Institute, Minneapolis, Minnesota.
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Bailey JE, Gurgol C, Pan E, Njie S, Emmett S, Gatwood J, Gauthier L, Rosas LG, Kearney SM, Robler SK, Lawrence RH, Margolis KL, Osunkwo I, Wilfley D, Shah VO. Early Patient-Centered Outcomes Research Experience With the Use of Telehealth to Address Disparities: Scoping Review. J Med Internet Res 2021; 23:e28503. [PMID: 34878986 PMCID: PMC8693194 DOI: 10.2196/28503] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/04/2021] [Accepted: 10/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health systems and providers across America are increasingly employing telehealth technologies to better serve medically underserved low-income, minority, and rural populations at the highest risk for health disparities. The Patient-Centered Outcomes Research Institute (PCORI) has invested US $386 million in comparative effectiveness research in telehealth, yet little is known about the key early lessons garnered from this research regarding the best practices in using telehealth to address disparities. OBJECTIVE This paper describes preliminary lessons from the body of research using study findings and case studies drawn from PCORI seminal patient-centered outcomes research (PCOR) initiatives. The primary purpose was to identify common barriers and facilitators to implementing telehealth technologies in populations at risk for disparities. METHODS A systematic scoping review of telehealth studies addressing disparities was performed. It was guided by the Arksey and O'Malley Scoping Review Framework and focused on PCORI's active portfolio of telehealth studies and key PCOR identified by study investigators. We drew on this broad literature using illustrative examples from early PCOR experience and published literature to assess barriers and facilitators to implementing telehealth in populations at risk for disparities, using the active implementation framework to extract data. Major themes regarding how telehealth interventions can overcome barriers to telehealth adoption and implementation were identified through this review using an iterative Delphi process to achieve consensus among the PCORI investigators participating in the study. RESULTS PCORI has funded 89 comparative effectiveness studies in telehealth, of which 41 assessed the use of telehealth to improve outcomes for populations at risk for health disparities. These 41 studies employed various overlapping modalities including mobile devices (29/41, 71%), web-based interventions (30/41, 73%), real-time videoconferencing (15/41, 37%), remote patient monitoring (8/41, 20%), and store-and-forward (ie, asynchronous electronic transmission) interventions (4/41, 10%). The studies targeted one or more of PCORI's priority populations, including racial and ethnic minorities (31/41, 41%), people living in rural areas, and those with low income/low socioeconomic status, low health literacy, or disabilities. Major themes identified across these studies included the importance of patient-centered design, cultural tailoring of telehealth solutions, delivering telehealth through trusted intermediaries, partnering with payers to expand telehealth reimbursement, and ensuring confidential sharing of private information. CONCLUSIONS Early PCOR evidence suggests that the most effective health system- and provider-level telehealth implementation solutions to address disparities employ patient-centered and culturally tailored telehealth solutions whose development is actively guided by the patients themselves to meet the needs of specific communities and populations. Further, this evidence shows that the best practices in telehealth implementation include delivery of telehealth through trusted intermediaries, close partnership with payers to facilitate reimbursement and sustainability, and safeguards to ensure patient-guided confidential sharing of personal health information.
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Affiliation(s)
- James E Bailey
- Tennessee Population Health Consortium, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Cathy Gurgol
- Patient-Centered Outcomes Research Institute, Washington, DC, United States
| | - Eric Pan
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Shirilyn Njie
- Westat Inc, Center for Healthcare Delivery Research and Evaluation, Rockville, MD, United States
| | - Susan Emmett
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Duke Global Health Institute, Durham, NC, United States
| | - Justin Gatwood
- College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Lynne Gauthier
- Department of Physical Therapy and Kinesiology, Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, MA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
- Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, United States
| | - Shannon M Kearney
- Solution Insights & Validation, Highmark Health, Pittsburgh, PA, United States
| | | | - Raymona H Lawrence
- Community Health Behavior and Education, Jiann-Ping College of Public Health, Georgia Southern University, Statesboro, GA, United States
| | | | - Ifeyinwa Osunkwo
- Cancer Care, Levine Cancer Institute, Atrium Health, Charlotte, NC, United States
| | - Denise Wilfley
- Department of Psychiatry, College of Medicine, Washington University in St. Louis, St Louis, MO, United States
| | - Vallabh O Shah
- Department of Internal Medicine and Biochemistry, School of Medicine, University of New Mexico, Albuquerque, NM, United States
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Counts NZ, Taylor LA, Willison CE, Galea S. Healthcare lobbying on upstream social determinants of health in the US. Prev Med 2021; 153:106751. [PMID: 34343593 PMCID: PMC8694571 DOI: 10.1016/j.ypmed.2021.106751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 10/20/2022]
Abstract
Healthcare stakeholders are increasingly investing to address social determinants of health (SDOH) as they seek to improve health outcomes and reduce total healthcare costs in their communities. Policy heavily shapes SDOH, and healthcare lobbying on SDOH issues may offer large impacts through positive policy change. Federal lobbying disclosures from the ten highest spending health insurance and healthcare provider organizations and related associations between 2015 and 2019 were reviewed to identify lobbying reported on the salient SDOH issues, defined based on the Accountable Health Communities Model health-related social needs screening tool. Five of the organizations reported lobbying on some SDOH issues, including financial strain, employment, food insecurity, and interpersonal safety, but none reported lobbying on other issues, such as non-healthcare-related employment, housing instability, transportation, or education. Lobbying has been a missed opportunity for addressing SDOH. Healthcare organizations have the opportunity to expand their lobbying on upstream SDOH policy issues to increase the impact of their SDOH strategy and further improve population health.
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Affiliation(s)
- Nathaniel Z Counts
- Mental Health America, Alexandria, VA, United States of America; Albert Einstein College of Medicine, The Bronx, NY, United States of America.
| | - Lauren A Taylor
- NYU Grossman School of Medicine, New York, NY, United States of America
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, United States of America
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Parry J, Vanstone M, Grignon M, Dunn JR. Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature. Int J Equity Health 2021; 20:219. [PMID: 34620188 PMCID: PMC8496150 DOI: 10.1186/s12939-021-01546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it. PURPOSE OF STUDY This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation. METHODS Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes. RESULTS Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs. CONCLUSION Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.
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Affiliation(s)
- Jane Parry
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - James R. Dunn
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
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