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Louie P, Brown HRH, Cobb RJ, Sheehan C. Are Interracial Couples at Higher Risk of Multiple Chronic Conditions? Evidence from a Nationally Representative Sample. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01952-y. [PMID: 38381328 DOI: 10.1007/s40615-024-01952-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/22/2024]
Abstract
Interracial relationships are becoming increasingly common in the United States, yet the physical health status of individuals in interracial relationships is not well understood. Using 18 years of pooled data from the National Health Interview Study (2001-2018) (N = 264, 891), we compared the odds of having multiple chronic conditions (MCC) among adults in interracial and same-race unions. We anticipate that individuals in interracial relationships may be at higher risk of MCC than individuals in same-race relationships due to increased exposure to stressors associated with crossing racial boundaries. Findings indicate that the implications of interracial relationships on MCC depended on the racial composition of the couple. We found that White-Black couples had higher odds of MCC than both White-White and Black-Black couples, but Asian-Black and Hispanic-Black couples did not differ from their same-race couple counterparts, indicating a pronounced and unique health disadvantage for White adults paired with Black adults. We also found that Asian-White and Hispanic-White couples had higher odds of MCC relative to their same-race counterparts. In addition, minority-minority couples generally did not differ from their same-race minority couple counterparts in terms of MCC. The results of the study provide new insights into how the racial composition of interracial unions impacts health and how a closer proximity to Whiteness may be a health risk for some minority groups.
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Affiliation(s)
- Patricia Louie
- Department of Sociology, University of Washington, Seattle, WA, USA.
| | - Hana R H Brown
- Department of Sociology, University of Washington, Seattle, WA, USA
| | - Ryon J Cobb
- Department of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - Connor Sheehan
- T. Denny Sanford School of Social and Family Dynamics, Tempe, AZ, USA
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Meraya AM, Kashan Syed N, Syed MH, Yasmeen A, Alfaifi MH, Alfaifi AJ, Hurubi KY, Khobrani MA, Alhossan A. Impact of COVID-19 related movement restrictions on the follow-up care visits of adults with chronic conditions: A Saudi arabian survey study. Saudi Pharm J 2023; 31:101846. [PMID: 38033751 PMCID: PMC10682654 DOI: 10.1016/j.jsps.2023.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/23/2023] [Indexed: 12/02/2023] Open
Abstract
Aims Lockdown measures implemented during the initial phase of the pandemic resulted in the delay and disruption of healthcare utilization for individuals with chronic conditions. We aimed to evaluate the impact of COVID-19 movement restrictions on the follow-up care visits of individuals with chronic illnesses. We also assessed the possible reasons patients missed their follow-ups and the potential barriers impeding follow-up during the pandemic. Methods A total of 397 adults with pre-existing medical conditions participated in an online cross-sectional survey from October to December 2022. The study sample comprised 57 % females and 43 % males, with a mean age of 43 years. A 36-item online self-report survey was used for data collection.Results: Fifty-five percent of participants reported missing their follow-up during COVID-19 pandemic, and 14 % made emergency department visits due to their missed follow-up appointments. In addition, 24 % experienced complications due to their missed appointments. The mean score on the fear of COVID-19 scale was 17.8 ± 6.5 (SD). For the majority of participants (60 %), pandemic-related restrictions were the predominant barrier to their follow-up visits. Additionally, we found that as individuals' COVID-19 fear scores increased, the likelihood of missing a follow-up care visit also increased (AOR: 1.067; p-value = 0.001). However, participants who did not perceive COVID-19 pandemic-related restrictions as a barrier were less likely to miss their follow-up visits (AOR: 0.581; p-value = 0.031). Furthermore, those who understood the significance of follow-up care were less likely to miss any of their follow-up visits (AOR: 0.224; p-value < 0.001) than those who had limited understanding of its importance. Conclusion The results showed that pandemic-related movement restrictions negatively affected attendance at follow-up visits for people with pre-existing health conditions. Initiatives should therefore be undertaken during global public health emergencies to provide medical and psychological support to vulnerable and high-risk groups.
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Affiliation(s)
- Abdulkarim M. Meraya
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Nabeel Kashan Syed
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Mamoon H. Syed
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Ayesha Yasmeen
- Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Mohammed H. Alfaifi
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Aseel J. Alfaifi
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Khalid Y. Hurubi
- Pharmacy Practice Research Unit, College of Pharmacy, Jazan University, Jazan P.O Box 114-45124, Saudi Arabia
| | - Moteb A. Khobrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Saudi Arabia
| | - Abdulaziz Alhossan
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Saudi Arabia
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Chi NC, Han S, Lin SY, Fu YK, Zhu Z, Nakad L, Demiris G. Resilience-enhancing interventions for family caregivers: A systematic review. Chronic Illn 2023:17423953231174928. [PMID: 37259541 DOI: 10.1177/17423953231174928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To synthesize interventions designed to enhance resilience in family caregivers (FCs). METHODS Electronic databases including PubMed, CINAHL, PsycINFO, and Scopus, were searched using index and keyword methods for articles published before January 2020. The review process followed the PRISMA review guidelines. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS Six studies (seven articles) were included in this review. Quantitative evidence supports the benefits of psychoeducation, mindfulness-based intervention, and cognitive behavioral therapy (CBT)-based intervention but not expressive writing in improving in FCs' resilience. Four of the six included studies were randomized controlled trials. All included studies only met 40% to 60% of the MMAT criteria, indicating low to moderate levels of study quality. CONCLUSION This review showed emerging evidence that psychoeducation, mindfulness-based intervention, and CBT-based intervention may improve caregiver resilience. However, it remains unclear which intervention and what dosage is the most effective in promoting FCs' resilience. Due to the small number of relevant studies and a low-to-moderate level of overall study quality, more rigorous clinical trials are needed to strengthen the current limited evidence base for FC resilience interventions.
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Affiliation(s)
- Nai-Ching Chi
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Soojeong Han
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Shih-Yin Lin
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Ying-Kai Fu
- College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Zilin Zhu
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - Lynn Nakad
- College of Nursing, University of Iowa, Iowa City, IA, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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Locatelli G, Matus A, James R, Salmoirago-Blotcher E, Ausili D, Vellone E, Riegel B. What is the role of interoception in the symptom experience of people with a chronic condition? A systematic review. Neurosci Biobehav Rev 2023; 148:105142. [PMID: 36965864 DOI: 10.1016/j.neubiorev.2023.105142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 03/20/2023] [Accepted: 03/21/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Interoception, the ability of the organism to sense, interpret, and regulate signals originating from within the body, plays an important role in how individuals perceive and respond to symptoms. However, there is scarce evidence on the role of interoception in the symptom experience of people with chronic conditions. AIM To synthesize the role of interoception in the symptom experience of adults with a chronic condition. METHODS Systematic review. We searched PubMed, Psychinfo, Embase, CINAHL, and Science Citation Index-Expanded. We included primary research (all study designs) addressing our study aim, published between 2013-2021, and measuring at least one dimension of interoception. Any chronic condition and any symptom were included. No language limits were applied. Only the adult population was included. RESULTS We included 18 quantitative studies investigating the relationship between three interoceptive dimensions (i.e., accuracy, sensibility, awareness) and condition-specific symptoms in 10 chronic conditions. People with chronic conditions had lower interoceptive accuracy than healthy controls. Higher interoceptive sensibility was associated with lower symptom severity/frequency. Higher interoceptive accuracy was associated with lower symptom severity/frequency in half of the studies, while the other half reported the opposite. Only one study explored interoceptive awareness. CONCLUSION Interoceptive abilities are lower in patients with chronic conditions. Higher interoceptive sensibility is associated with lower symptom severity/frequency, but this relationship is unclear when it comes to interoceptive accuracy and awareness.
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Affiliation(s)
- Giulia Locatelli
- Department of biomedicine and prevention, University of Rome Tor Vergata, Italy; Faculty of Health Sciences, Australian Catholic University, Australia.
| | - Austin Matus
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Richard James
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | | | - Davide Ausili
- School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Ercole Vellone
- Department of biomedicine and prevention, University of Rome Tor Vergata, Italy
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, USA
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Wetmore JB, Chernov C, Perlman SE, Borrell LN. Associations of Health Conditions and Health-Related Determinants with Disability among New York City Adult Residents. Ethn Dis 2021; 31:445-452. [PMID: 34295132 DOI: 10.18865/ed.31.3.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Population-based disability prevalence estimates are limited for New York City (NYC). We examined the association of several health and health-related measures with disability among NYC residents aged 20-64 years. Methods We used information from 1,314 adults who participated in the 2013-2014 NYC Health and Nutrition Examination Survey (HANES). We categorized survey participants as having a disability if they reported a physical, mental, and/or emotional problem preventing work or if they reported difficulty walking without special equipment because of a health problem. We used log-binomial regression to quantify the association of each exposure with disability before and after adjustment for select covariates. Results Overall, 12.4% of the study's NYC residents aged 20-64 years had a disability. After adjustment, disability prevalence was significantly greater among those who reported having unmet health care needs (prevalence ratio [PR] = 1.75, 95% CI: 1.18-2.57) and those who reported fair/poor general health (PR = 2.33, 95% CI: 1.68-3.24). The probability of disability was greater among NYC residents with arthritis (PR = 2.66, 95% CI: 1.85-3.98) and hypertension (PR = 1.48, 95% CI: 1.04-2.11) when compared with those without these conditions. Disability was also associated with depression (PR = 2.96, 95% CI: 2.06-4.25), anxiety (PR = 2.89, 95% CI: 2.15-3.88), and post-traumatic stress disorder (PR = 2.55, 95% CI: 1.66-3.91). Disability, however, was not associated with diabetes. Conclusion Disability is more prevalent among those with unmet health care needs, fair/poor general health, arthritis, hypertension, depression, anxiety, and PTSD in these NYC residents, aged 20-64 years. These findings have implications for NYC's strategic planning initiatives, which can be better targeted to groups disproportionately affected by disability.
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Affiliation(s)
- John B Wetmore
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Claudia Chernov
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Sharon E Perlman
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY
| | - Luisa N Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
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Oh SN, Kim YA, Kim YJ, Shim HJ, Song EK, Kang JH, Kwon JH, Lee JL, Lee SN, Maeng CH, Kang EJ, Do YR, Yun HJ, Jung KH, Yun YH. The Attitudes of Physicians and the General Public toward Prognostic Disclosure of Different Serious Illnesses: a Korean Nationwide Study. J Korean Med Sci 2020; 35:e401. [PMID: 33289368 PMCID: PMC7721562 DOI: 10.3346/jkms.2020.35.e401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/14/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. METHODS We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. RESULTS For most illnesses, most physicians (adjusted proportions - end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was "the patient's right to know his/her condition" (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was "psychological burden such as anxiety and depression" (35.8%), while for the physicians it was "disclosure would have no beneficial effect" (42.4%). CONCLUSION Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.
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Affiliation(s)
- Si Nae Oh
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Young Ae Kim
- Hospice & Palliative Care Branch, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yu Jung Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyun Jeong Shim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Chonnam National University School of Medicine, Hwasun, Korea
| | - Eun Kee Song
- Division of Hematology/Oncology, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jung Hun Kang
- Department of Internal Medicine, College of Medicine, Gyeongsang National University, Jinju, Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung Lim Lee
- Department of Hemato-oncology, Daegu Fatima Hospital, Daegu, Korea
| | - Soon Nam Lee
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chi Hoon Maeng
- Division of Medical Oncology and Hematology, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Eun Joo Kang
- Division of Medical Oncology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Young Rok Do
- Department of Internal Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Kyung Hae Jung
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ho Yun
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Hero JO, Sinaiko AD, Kingsdale J, Gruver RS, Galbraith AA. Decision-Making Experiences Of Consumers Choosing Individual-Market Health Insurance Plans. Health Aff (Millwood) 2020; 38:464-472. [PMID: 30830810 DOI: 10.1377/hlthaff.2018.05036] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The health insurance Marketplaces established by the Affordable Care Act include features designed to simplify the process of choosing a health plan in the individual, or nongroup, insurance market. While most individual health insurance enrollees purchase plans through the federal and state-based Marketplaces, millions also purchase plans directly from an insurance carrier (off Marketplace). This study was a descriptive comparison of the decision-making processes and shopping experiences of consumers in two states who purchased a health insurance plan from the same large insurer in 2017, either through the federal Marketplaces or off Marketplace. In a survey, those who selected plans through the Marketplaces reported less difficulty finding the best or most affordable plan than did those enrolling off Marketplace. Respondents in families with chronic health conditions who enrolled through the Marketplaces reported better overall experiences than those who enrolled off Marketplace. Respondents with low health insurance literacy reported poor experiences in enrolling both through the Marketplaces and off Marketplace. Access to consumer assistance in the individual health insurance market should target off-Marketplace populations as well as all populations with low health insurance literacy.
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Affiliation(s)
- Joachim O Hero
- Joachim O. Hero ( ) is a research fellow in health policy at the Harvard Pilgrim Health Care Institute and Harvard Medical School, in Boston, Massachusetts
| | - Anna D Sinaiko
- Anna D. Sinaiko is an assistant professor of health economics and policy in the Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, in Boston
| | - Jon Kingsdale
- Jon Kingsdale is an associate professor of the practice in the Department of Health Law, Policy, and Management, Boston University School of Public Health, in Massachusetts, and an adjunct professor of the practice at Brown University, in Providence, Rhode Island
| | - Rachel S Gruver
- Rachel S. Gruver is a doctoral student in epidemiology at the Columbia University Mailman School of Public Health, in New York City. At the time this work was conducted, she was a project manager at the Harvard Pilgrim Health Care Institute
| | - Alison A Galbraith
- Alison A. Galbraith is an associate professor of population medicine at the Harvard Pilgrim Health Care Institute and Harvard Medical School
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Schroeder J, Karkar R, Murinova N, Fogarty J, Munson SA. Examining Opportunities for Goal-Directed Self-Tracking to Support Chronic Condition Management. Proc ACM Interact Mob Wearable Ubiquitous Technol 2019; 3:151. [PMID: 32656490 PMCID: PMC7351123 DOI: 10.1145/3369809] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although self-tracking offers potential for a more complete, accurate, and longer-term understanding of personal health, many people struggle with or fail to achieve their goals for health-related self-tracking. This paper investigates how to address challenges that result from current self-tracking tools leaving a person's goals for their data unstated and lacking explicit support. We examine supporting people and health providers in expressing and pursuing their tracking-related goals via goal-directed self-tracking, a novel method to represent relationships between tracking goals and underlying data. Informed by a reanalysis of data from a prior study of migraine tracking goals, we created a paper prototype to explore whether and how goal-directed self-tracking could address current disconnects between the goals people have for data in their chronic condition management and the tools they use to support such goals. We examined this prototype in interviews with 14 people with migraine and 5 health providers. Our findings indicate the potential for scaffolding goal-directed self-tracking to: 1) elicit different types and hierarchies of management and tracking goals; 2) help people prepare for all stages of self-tracking towards a specific goal; and 3) contribute additional expertise in patient-provider collaboration. Based on our findings, we present implications for the design of tools that explicitly represent and support an individual's specific self-tracking goals.
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Affiliation(s)
| | - Ravi Karkar
- Computer Science & Engineering, University of Washington
| | | | - James Fogarty
- Computer Science & Engineering, University of Washington
| | - Sean A Munson
- Human Centered Design & Engineering, University of Washington
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Pearson CF, Quinn CC, Loganathan S, Datta AR, Mace BB, Grabowski DC. The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care. Health Aff (Millwood) 2019; 38:101377hlthaff201805233. [PMID: 31017490 DOI: 10.1377/hlthaff.2018.05233] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
As people age and require more assistance with daily living and health needs, a range of housing and care options is available. Over the past four decades the market for seniors housing and care-including assisted living and independent living communities-has greatly expanded to accommodate people with more complex needs. These settings provide housing in a community environment that often includes personal care assistance services. Unfortunately, these settings are often out of the financial reach of many of this country's eight million middle-income seniors (those ages seventy-five and older). The private seniors housing industry has generally focused on higher-income people instead. We project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high health care and functional needs. While many of these seniors will likely need the level of care provided in seniors housing, we project that 54 percent of seniors will not have sufficient financial resources to pay for it. This gap suggests a role for public policy and the private sector in meeting future long-term care and housing needs for middle-income seniors.
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Affiliation(s)
- Caroline F Pearson
- Caroline F. Pearson ( ) is a senior vice president at NORC at the University of Chicago in Illinois
| | - Charlene C Quinn
- Charlene C. Quinn is an associate professor in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine, in Baltimore
| | - Sai Loganathan
- Sai Loganathan is a senior health economist at NORC at the University of Chicago in Bethesda, Maryland
| | - A Rupa Datta
- A. Rupa Datta is a vice president at NORC at the University of Chicago in Illinois
| | - Beth Burnham Mace
- Beth Burnham Mace is chief economist at the National Investment Center for Seniors Housing and Care, in Annapolis, Maryland
| | - David C Grabowski
- David C. Grabowski is a professor in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
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10
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018; 28:325-338. [PMID: 30202185 DOI: 10.18865/ed.28.s2.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Significance Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design Secondary analyses of a cluster-randomized trial. Setting 93 health care and community-based programs in two neighborhoods. Participants Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018. [PMID: 30202185 DOI: 10.18865/ed.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
SIGNIFICANCE Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. OBJECTIVE To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. DESIGN Secondary analyses of a cluster-randomized trial. SETTING 93 health care and community-based programs in two neighborhoods. PARTICIPANTS Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. INTERVENTION CEP or RS for implementing depression quality improvement programs. OUTCOMES AND ANALYSES Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). RESULTS Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. CONCLUSIONS CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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Agrawal S, Agrawal PK. Association Between Body Mass index and Prevalence of Multimorbidity in Low-and Middle-income Countries: A Cross-Sectional Study. ACTA ACUST UNITED AC 2016; 6:73-83. [PMID: 28894693 PMCID: PMC5591643 DOI: 10.5530/ijmedph.2016.2.5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Chronic diseases are increasingly becoming a health burden in terms of both morbidity and mortality in low and middle-income countries (LMICs). The role of body mass index (BMI) especially overweight and obesity in the prevalence of multimorbidity, the occurrence of two or more chronic conditions, is understudied in LMICs where two thirds of the world’s obese individuals reside. We estimated the association between BMI and prevalence of chronic non communicable disease multimorbidity in six LMICs. Methods Cross-sectional data of total of 40,166 participants from China (n=13,970), India (10,915), Mexico (2,4 26), Russia (3,892), South Africa (4,000) and Ghana (4,971), aged 18 years and above included in the WHO Study on Global Ageing and adult health (SAGE), 2007–2010 were analyzed. Multimorbidity was measured as the simultaneous presence of two or more of the nine chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, depression, and vision impairment. Multivariable logistic regression models were fitted to test for associations between overweight/obesity and prevalence of non communicable multimorbidity after adjusting for age, sex, rural/urban residence, education, marital status, occupation, household wealth, tobacco smoking, alcohol drinking, fruits and vegetable intake and health insurance status. Data were analyzed country wise as well as pooled together to give overall LMIC estimates. Results The mean BMI was 24.4 [±7.3SD] in the pooled countries, being as low as 20.8 [±8.0 SD] in India to 23.4 [±6.3 SD] in Ghana, 23.9 [±4.9 SD] in China, 28.4 [±5.4 SD] in Mexico, 28.6 [±6.3 SD] in Russia, to as high as 30.5 [±12.0 SD] in South Africa. The prevalence of overweight was 13% and obesity was 24% in the pooled sample. The prevalence of non communicable disease multimorbidity was 23% in the pooled sample of six countries–the highest being in Russia (50%), followed by Mexico (27%), India (24%), Ghana (23%), South Africa (32%) and China (22%). The prevalence of multimorbidity was 37% among obese population and 27% among overweight population in the pooled sample–highest prevalence was in Russia (59% among obese; 45% among overweight) and lowest in Ghana (28% among obese; 23% among overweight). Being obese (OR:5.78;95%CI:3.55–9.40;p<0.0001) was associated with significantly higher likelihood of having multimorbidity as compared to normal weight category in the pooled sample. The likelihood of multimorbidity among obese were almost ten times higher in Russia (OR:9.90;95%CI:3.90–25.17;p=<0.0001), seven times higher in China (OR:7.06;95%CI:2.47–20.21;p=0.003), six times higher in Ghana (OR:5.61;95%CI:1.21–26.02;p= 0.007) and five times higher in South Africa (OR:4.66;95%CI:2.16–10.08;p=0.005). Non-significant but positive association were also observed in case of India and Mexico. The likelihood of multimorbidity was more than two times higher among overweight population in India (OR:2.33;95%CI:1.35–4.02;p=0.003) and pooled countries (OR:1.47;95%CI:1.05–2.07;p=0.004) while non-significant but positive association were also observed in case of China, Russia, and Ghana. Conclusions The prevalence of non communicable disease multimorbidity in the LMICs is high, one and half times higher in obese than in normal weight individual. Obesity was independently associated with the occurrence of multimorbidity in the six LMICs. These findings may be vital for public health surveillance, prevention and management strategies for non communicable disease multimorbidity in the LMICs.
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Mallow JA, Petitte T, Narsavage G, Barnes E, Theeke E, Mallow BK, Theeke LA. The Use of Video Conferencing for Persons with Chronic Conditions: A Systematic Review. Ehealth Telecommun Syst Netw 2016; 5:39-56. [PMID: 29104830 PMCID: PMC5669274 DOI: 10.4236/etsn.2016.52005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of this paper is to present a systematic review of studies that used Video Conferencing (VC) intervention for common chronic conditions. Chronic conditions account for the majority of poor health, disability, and death, and for a major portion of health-care expenditures in the United States. Innovative methods and interventions are needed to enhance care and management, improve access to care, improve patient outcomes, narrow health disparities and reduce health-care costs. Video Conferencing could be particularly relevant in improving health, care management, access and cost in the care of chronic illnesses. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 27 articles measuring video conferencing, at least one chronic illness, and patient outcomes for adults living in a community setting. While VC has been found to be feasible and effective, a low number of randomized controlled trials limit evidence. In addition, studies in this review were not designed to address the question of whether access to care in rural areas is improved through VC. Hence, more research is needed.
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Affiliation(s)
| | - Trisha Petitte
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | | | - Emily Barnes
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | - Elliott Theeke
- School of Nursing, West Virginia University, Morgantown, WV, USA
| | | | - Laurie A Theeke
- School of Nursing, West Virginia University, Morgantown, WV, USA
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Theeke LA, Mallow J, Gianni C, Legg K, Glass C. The Experience of Older Women Living with Loneliness and Chronic Conditions in Appalachia. ACTA ACUST UNITED AC 2015; 39:61-72. [PMID: 26594267 DOI: 10.1037/rmh0000029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This phenomenological qualitative study explored the experience of living with loneliness and multiple chronic conditions for rural older women in Appalachia. The study took place in 2012 in Northern West Virginia. Participants were 14 older women who were chronically ill, community dwelling, and lonely (Score of 40 or higher on the Revised 20-item UCLA Loneliness Scale). Thematic content analysis revealed four categories that contained thirteen themes: (a) negative emotions of loneliness, which included themes of sadness, disconnection, fear, anger, and worry; (b) positive emotions when not lonely, which included themes of joy with others and pride in self; (c) loss of independence and loneliness, which included themes of functional decline contributes to loneliness, burden, and gratitude for help; and (d) ways of managing loneliness, which included remembering holidays and happier moments, staying busy, and getting out. The study contributes new knowledge about the experience of anger, fear, and worry when lonely. These emotions have not extensively been identified as significant to loneliness. Future studies exploring the links between loneliness and anger, fear, worry, and negative physical health outcomes could enhance knowledge of mechanisms by which loneliness contributes to health decline. Additionally, knowing that positive emotions such as joy are described as being linked to less lonely times could inform future work that aims to diminish loneliness and enhance positive emotional states. Finally, understanding that functional impairment is described as contributing to loneliness in this population reinforces the need to assess for and address functional limitations.
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Hayes DK, Feigal DW, Smith RA, Fuddy LJ. Maternal asthma, diabetes, and high blood pressure are associated with low birth weight and increased hospital birth and delivery charges; Hawai'i hospital discharge data 2003-2008. Hawaii J Med Public Health 2014; 73:49-57. [PMID: 24567868 PMCID: PMC3931410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (<2500 grams), high birth weight (>4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.
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Affiliation(s)
- Donald K Hayes
- Hawai'i Department of Health, Honolulu, HI (DKH, DWF, LJF)
| | - David W Feigal
- Hawai'i Department of Health, Honolulu, HI (DKH, DWF, LJF)
| | - Ruben A Smith
- Hawai'i Department of Health, Honolulu, HI (DKH, DWF, LJF)
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Mallow JA, Theeke LA, Barnes ER, Whetsel T, Mallow BK. Free Care Is Not Enough: Barriers to Attending Free Clinic Visits in a Sample of Uninsured Individuals with Diabetes. ACTA ACUST UNITED AC 2014; 4:912-919. [PMID: 25767743 PMCID: PMC4354849 DOI: 10.4236/ojn.2014.413097] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Free care does not always lead to improved outcomes. Attendance at free clinic appointments is unpredictable. Understanding barriers to care could identify innovative interventions. The purpose of this study was to examine patient characteristics, biophysical outcomes, and health care utilization in uninsured persons with diabetes at a free clinic. A sample of 3139 patients with at least one chronic condition was identified and comparisons were made between two groups: those who attended all scheduled appointments and those who did not. Geographic distance to clinic and multiple chronic conditions were identified as barriers to attendance. After one year, missing more than one visit had a positive correlation with increased weight, A1C, and lipids. Additionally, patients who missed visits had higher blood pressure, depression scores, and numbers of medications. Future research should further enhance understanding of barriers to care, build knowledge of how social and behavioral determinants contribute to negative outcomes in the context of rurality. Innovative methods to deliver more frequent and intensive interventions will not be successful if they are not accessible to patients.
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Affiliation(s)
- Jennifer A Mallow
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Laurie A Theeke
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Emily R Barnes
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
| | - Tara Whetsel
- School of Nursing, West Virginia University, Morgantown, West Virginia, USA
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Abstract
OBJECTIVE Analyze differences in Medicare Fee-for-Service utilization (i.e., program payments) by beneficiary characteristics, such as gender, age, and prevalence of chronic conditions. METHODS Using the 2008 and 2010 Chronic Conditions Public Use Files, we conduct a descriptive analysis of enrollment and program payments by gender, age categories, and eleven chronic conditions. RESULTS We find that the effect of chronic conditions on Medicare payments is dramatic. Average Medicare payments increase significantly with the number of chronic conditions. Finally, we quantify the effect of individual conditions and find that "Stroke / Transient Ischemic Attack" and "Chronic Kidney Disease" are the costliest chronic conditions for Part A, and "Cancer" and "Chronic Kidney Disease" are the costliest for Part B.
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Affiliation(s)
| | - Sergio I. Prada
- PROESA-Research Center for Social Protection and Health Economics
- Universidad Icesi
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Stuifbergen AK, Morris M, Jung JH, Pierini D, Morgan S. Benefits of wellness interventions for persons with chronic and disabling conditions: a review of the evidence. Disabil Health J 2011; 3:133-45. [PMID: 20628583 DOI: 10.1016/j.dhjo.2009.10.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Persons living with the effects of chronic and disabling conditions are often at increased risk for the development of secondary conditions and disabilities that can lead to further decline in health status, independence, functional status, life satisfaction, and overall quality of life. OBJECTIVE The purpose of this study was to review the evidence for the benefits of wellness/health promotion interventions for persons with chronic and disabling conditions. METHODS The authors conducted a Medline search (1990-2007) using terms related to wellness and health promotion cross-referenced with general terms for chronic and disabling conditions, as well as 15 specific chronic and/or disabling conditions (e.g., multiple sclerosis, spinal cord injury). Selection of studies was limited to those published in English that reported randomized controlled trails or prospective studies that involved adult human subjects with a chronic and/or disabling condition. All selected studies focused on some aspect of a wellness or health promotion intervention and involved a comparison or control group. Of the 5,847 studies initially identified in the search using medical subject heading terms, 190 met the criteria for full review. Data were extracted from these publications and summarized using descriptive statistics. RESULTS Almost all studies (95%) explored the effects of wellness intervention in a sample diagnosed with a single condition (e.g., cancer, stroke, arthritis). Although the mean sample size was 100, the range in sample size varied widely (6-688); 25% of the studies had sample of 30 or fewer. Almost all studies (89.5%) reported positive effects of the wellness intervention, although the delivery and content of interventions as well as the measurement of outcomes, varied greatly. CONCLUSIONS Our findings support an immediate post-intervention positive impact of wellness interventions across persons with a wide variety of chronic and disabling conditions. Future research that clearly specifies primary study outcomes and follows the CONSORT guidelines will strengthen future reviews of the evidence and facilitate application of the evidence of practice.
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Affiliation(s)
- Alexa K Stuifbergen
- The University of Texas at Austin School of Nursing, Center for Health Promotion and Disease Prevention Research in Underserved Populations, 1700 Red River, Austin, Texas 78701, USA.
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