Health care administration and drug policy

The American healthcare system faces a potential reorganization of the way in which services are provided and financed. We argue that healthcare administrators need to be increasingly aware of the ways in which our nation's illicit drug policy, commonly referred to as the 'War on Drugs', affects the provision of health services. A large and growing portion of the US population uses one or more of the currently illegal drugs and some of these persons suffer from an addiction or other substance use disorder. This is clearly demonstrated by the current opioid epidemic which is not yet being adequately controlled. Providing specialty treatment for drug abuse disorders will be increasingly important for healthcare administrators thanks to recent mental health parity legislation. At the same time, drug users and abusers will be increasingly encountered while providing care not specifically tied to drug use or abuse. The character of our current national drug policy has an important impact on how drug abuse disorders are treated and how the health delivery system responds to drug users who are increasingly often encountered in primary care, emergency care, specialty care, and long-term care settings.

Acupuncture Use in the United States: Who, Where, Why, and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.

Variability between self-reported diabetes and measured glucose among health screening participants in South Central Kentucky

AIMS

To assess self-reported diabetes and random glucose among health screening participants and examine factors associated with these two diabetes outcomes.

METHODS

Study subjects were adults aged ≥18 years who participated in diabetes screenings via a mobile health clinic operated by the Institute for Rural Health at Western Kentucky University from 2006 to 2011. Data on self-reported diabetes were based on physicians' past diagnosis. Random plasma glucose was obtained during the screenings. Non-fasting plasma glucose levels of ≥180mg/dl and ≥140mg/dl were used as cutoffs to determine diabetes and diabetes or pre-diabetes, respectively. Logistic regression was used to examine factors associated with self-reported diabetes and elevated non-fasting glucose levels controlling for comorbidities and sociodemographic factors.

RESULTS

The proportion of self-reported diabetes was 9.6%. The proportion of participants with ≥180mg/dl was 3.2% and that with ≥140mg/dl was 7.4%. Odds ratios indicated that self-reported diabetes was higher in older and obese groups and those who had hypertension and hypercholesterolemia and family history of diabetes, while elevated non-fasting glucose levels were higher among participants without health insurance and those who reported they had diabetes.

CONCLUSIONS

Variability in risks between self-reported diabetes and measured glucose should be incorporated in diabetes self-care.

Dental caries among children visiting a mobile dental clinic in South Central Kentucky: a pooled cross-sectional study

BACKGROUND

Dental caries is one of the most common chronic childhood diseases affecting a large portion of children in the United States. The prevalence of childhood dental caries in Kentucky is among the highest in the nation. The purposes of this study are to (1) compare sociodemographic differences between caries and no caries groups and (2) investigate factors associated with untreated dental caries among children who visited a mobile dental clinic in South Central Kentucky.

METHODS

Study subjects were children aged 6 to 15 years who participated in the school-based dental sealant program through the mobile dental clinic operated by the Institute for Rural Health at Western Kentucky University between September 2006 and May 2011 (n = 2,453). Descriptive statistics were calculated for sociodemographic factors (age, gender, race/ethnicity, insurance status, and urban versus rural residential location) and caries status. We used chi-square tests to compare sociodemographic differences of children stratified by caries and no caries status as well as three levels of caries severity. We developed a logistic regression model to investigate factors associated with untreated dental caries while controlling for sociodemographic characteristics.

RESULTS

The proportion of children having untreated dental caries was 49.7% and the mean number of untreated dental caries was 2.0. The proportion of untreated dental caries was higher in older children, children with no insurance and living in rural residential locations, and caries severity was also higher in these groups. Odds ratio indicated that older ages, not having private insurance (having only public, government-sponsored insurance or no insurance at all) and rural residential location were associated with having untreated dental caries after controlling for sociodemographic characteristics of children.

CONCLUSIONS

Untreated dental caries was more likely to be present in older children living in rural areas without insurance. Health interventionists may use this information and target rural children without having proper insurance in order to reduce geographic disparities in untreated dental caries in South Central Kentucky.